1699841601 NPI number — OWENS OPTICAL OF WETUMPKA INC

Table of content: EDWIN PALMER CCP (NPI 1194025908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699841601 NPI number — OWENS OPTICAL OF WETUMPKA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OWENS OPTICAL OF WETUMPKA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699841601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6255 US HIGHWAY 231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETUMPKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36092-2831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-567-2282
Provider Business Mailing Address Fax Number:
334-514-1134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6255 US HIGHWAY 231
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WETUMPKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36092-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-567-2282
Provider Business Practice Location Address Fax Number:
334-514-1134
Provider Enumeration Date:
11/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUNDAY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MERVIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-567-2282

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51059498 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51059704 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".