Organization
DRS SIMON & MEDLOCK PRTNR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD DAVID MEDLOCK OD (PARTNER)
(205) 560-0477
Entity
Organization
Contact information
Practice address
832 PRINCETON AVE SW, BIRMINGHAM, AL 35211-1320
(205) 780-7053
(205) 206-8368
Mailing address
PO BOX 360064, HOOVER, AL 35236-0064
(205) 560-0477
(205) 560-0477
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S587TA195; S592TA197
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E659
MEDICARE GROUP NUMBER
AL
Enumeration date
09/28/2006
Last updated
11/12/2010
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