Basic Information
| Provider Information | |||||||||
| NPI: | 1891917233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HOUR GLASS OF ALBANY, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 TIMBERLANE RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323121713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508934687 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2610 DAWSON RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317071682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294394687 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEPHENS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2294394687 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 920511-DU | GA | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.