Provider Demographics
NPI:1538179866
Name:ENTERPRISE OPTICAL LLC
Entity type:Organization
Organization Name:ENTERPRISE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-393-2020
Mailing Address - Street 1:812 E. LEE
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330
Mailing Address - Country:US
Mailing Address - Phone:334-393-2020
Mailing Address - Fax:334-393-6936
Practice Address - Street 1:812 E. LEE
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330
Practice Address - Country:US
Practice Address - Phone:334-393-2020
Practice Address - Fax:334-393-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL111905OtherEYEMED
AL51004506OtherBLUE CROSS BLUE SHIELD
ALL075Medicare PIN
ALT69112Medicare UPIN
AL111905OtherEYEMED