Individual
DR. DARYL G CUSTRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1499 N AIRPORT RD, JASPER, AL 35504-8882
(205) 221-3721
(205) 221-2748
Mailing address
1499 N AIRPORT RD, JASPER, AL 35504-8882
(205) 221-3721
(205) 221-2748
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-505-TA-126
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059727
—
AL
01
—
051546600
BCBS OF AL
AL
01
—
0555770001
MEDICARE NSC
—
01
—
103022
ALABAMA MEDICAID
AL
Enumeration date
08/30/2006
Last updated
11/11/2010
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