Organization
DECATUR OPTICAL DISPENSARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK LYNN HOLBERT (PRESIDENT)
(256) 351-0040
Entity
Organization
Contact information
Practice address
201 6TH AVE SE, DECATUR, AL 35601-3115
(256) 351-0040
(256) 301-9449
Mailing address
201 6TH AVE SE, DECATUR, AL 35601-3115
(256) 351-0040
(256) 301-9449
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059076
—
AL
Enumeration date
06/21/2006
Last updated
01/14/2015
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