Organization
SELMA FAMILY PRACTICE OPTOMETRY, INC.
Active
Other names
Eyemax Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WILLIE F SMITH MANAGER (OPTICIAN)
(334) 289-1008
Entity
Organization
Contact information
Practice address
1502 HIGHWAY 80E, SUITE A, DEMOPOLIS, AL 36732-0799
(334) 289-1008
(334) 289-1009
Mailing address
PO BOX 799, DEMOPOLIS, AL 36732-0799
(334) 289-1008
(334) 289-1009
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S435TA115
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000055527
—
AL
01
—
51055527
BLUE CROSS
AL
Enumeration date
01/24/2007
Last updated
01/24/2011
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