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) 872-2321
Entity
Organization
Contact information
Practice address
2401 MEDICAL CENTER PKWY, SELMA, AL 36701-7756
(334) 872-2321
Mailing address
2401 MEDICAL CENTER PKWY, SELMA, AL 36701-7756
(334) 872-2321
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-435-TA-115
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000095573
—
AL
01
—
51095573
BLUE CROSS
AL
01
—
529904900
GROUP NUMBER
AL
Enumeration date
10/24/2006
Last updated
01/24/2011
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