Provider Demographics
NPI:1093102386
Name:MOBILE BAY VISION, LLC
Entity type:Organization
Organization Name:MOBILE BAY VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-433-7717
Mailing Address - Street 1:301 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-4037
Mailing Address - Country:US
Mailing Address - Phone:251-433-7717
Mailing Address - Fax:251-433-9384
Practice Address - Street 1:301 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-4037
Practice Address - Country:US
Practice Address - Phone:251-433-7717
Practice Address - Fax:251-433-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSD-27-TA-989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty