Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 55292 Hwy 17, Sulligent, Alabama |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1255661070 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | S-C05-TA-838 (Alabama) | Primary |
Provider Name | Angela D Rayburn |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1831423680 PECOS PAC ID: 9032245832 Enrollment ID: I20100331000744 |
Mailing Address | Practice Location Address |
---|---|
Po Box 335, Sulligent, AL 35586-0335 Ph: (205) 698-7020 | 55292 Hwy 17, Sulligent, AL 35586 Ph: (205) 698-7020 |
Angela D. Rayburn, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 55292 Highway 17, Sulligent, AL 35586 Phone: 205-698-7020 |