Organization
COOSA EYE ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
P. DUNCAN ROY JR. O.D. (OWNER)
(256) 378-5507
Entity
Organization
Contact information
Practice address
34011 US HIGHWAY 280, CHILDERSBURG, AL 35044-2128
(256) 378-5507
(256) 378-5325
Mailing address
PO BOX J, CHILDERSBURG, AL 35044-0510
(256) 378-5507
(256) 378-5325
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-471-TA-079
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059662
—
AL
01
—
102G703418
MEDICARE ID
AL
01
—
510-59662
BLUE CROSS
AL
Enumeration date
11/29/2006
Last updated
03/06/2012
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