| Name: | Maynor & Mitchell Optical Shop, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 20 Aug 2002 (22 years ago) |
| Entity Number: | 000-684-156 |
| Register Number: | 000684156 |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 3501 SOUTH MEMORIAL PKWYHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Principal Address: | HUNTSVILLE, AL |
Activities
SELL EYEGLASSES & RELATED EYE WEAR
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578589107 | 2006-07-15 | 2014-05-28 | 3501 MEMORIAL PKWY SW STE 200, HUNTSVILLE, AL, 358016901, US | 3501 MEMORIAL PKWY SW STE 200, HUNTSVILLE, AL, 358016901, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-533-0315 |
| Fax | 2565360360 |
Authorized person
| Name | WILLIAM N MITCHELL |
| Role | OWNER |
| Phone | 2565330315 |
Taxonomy
| Taxonomy Code | 332H00000X - Eyewear Supplier |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 332H00000X - Eyewear Supplier |
| License Number | MD21789 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | 51511477 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529916870 |
| State | AL |
| Name | Role |
|---|---|
| MITCHELL, WILLIAM N | Agent |
| Name | Role | Address |
|---|---|---|
| MAYNOR, ROBERT C JR | Member | 300 BERRY HOLLOW RDGURLEY, AL 35748 |
| MITCHELL, WILLIAM N | Member | No data |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
