NPIMap

Organization Active NPI

Marvelous Eyes, LLC

  • Optician
  • Madison, AL
National Provider Identifier
1104222934
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
MARVELOUS EYES, LLC
Practice address
419 John Henry Way Ste C
Madison, AL 35757-9608
Phone
(256) 325-9175
NPI assigned
Nov 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly P Shaw
Title
President
Phone
(205) 683-3232

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X Primary

Addresses

Primary practice location

419 John Henry Way Ste C
Madison, AL 35757-9608

Mailing address

419 John Henry Way Ste C
Madison, AL 35757-9608
Phone (256) 325-9175

Other names 1

  • Deerfoot Eye Care Doing business as

National Provider Directory

National Provider Directory

Locations

419 John Henry Way
Ste C
Madison, AL 35757
Phone (256) 325-9175

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1104222934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 JOHN HENRY WAY STE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357579608",
            "telephone_number": "256-325-9175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 JOHN HENRY WAY STE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357579608",
            "telephone_number": "256-325-9175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVELOUS EYES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-05",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-683-3232"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deerfoot Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deerfoot Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.