Individual
ANGELA D. RAYBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
55292 HIGHWAY 17, SULLIGENT, AL 35586
(205) 698-7020
Mailing address
PO BOX 335, SULLIGENT, AL 35586-0335
(205) 698-7020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-C05-TA-838
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I413114
MEDICARE PTAN
AL
01
—
6343010001
MEDICARE/DME SUPPLIER PTAN
AL
Enumeration date
09/28/2009
Last updated
07/07/2017
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