Provider Demographics
NPI:1679795397
Name:HOUR GLASS INC
Entity type:Organization
Organization Name:HOUR GLASS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-893-4687
Mailing Address - Street 1:1480 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1713
Mailing Address - Country:US
Mailing Address - Phone:850-893-4687
Mailing Address - Fax:850-893-6098
Practice Address - Street 1:1433 E LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4747
Practice Address - Country:US
Practice Address - Phone:850-877-4687
Practice Address - Fax:850-877-0551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUR GLASS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL198700209840036332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19604OtherSPECTERA
FL19604OtherSPECTERA