Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 311 1st Street, Reform, Alabama |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1043313661 | NPI | - | NPPES |
009961460 | Medicaid | AL | |
051500677 | Other | AL | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | S914TA467 (Alabama) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 59, 311 1st Street, Reform, AL 35481-0059 Ph: (205) 375-8200 | 311 1st Street, Reform, AL 35481 Ph: (205) 375-8200 |