Provider Demographics
NPI:1588433783
Name:THE LENS DOC, LLC
Entity type:Organization
Organization Name:THE LENS DOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:251-490-9946
Mailing Address - Street 1:10 S MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1222
Mailing Address - Country:US
Mailing Address - Phone:205-746-0777
Mailing Address - Fax:
Practice Address - Street 1:1088 INDUSTRIAL PKWY STE 4
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3708
Practice Address - Country:US
Practice Address - Phone:251-675-3666
Practice Address - Fax:251-675-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty