Individual
MR. LEROY MAXWELL SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD MPH
Contact information
Practice address
2401 MEDICAL CENTER PKWY, SELMA, AL 36701-7756
(334) 872-2321
(334) 872-2391
Mailing address
PO BOX 650, SELMA, AL 36701-0650
(334) 872-2321
(334) 872-2391
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S435TA115
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000095573
—
AL
01
—
051095573
BLUE CROSS
AL
Enumeration date
08/15/2006
Last updated
10/15/2010
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