Organization
SELMA FAMILY PRACTICE OPTOMETRY, INC.
Active
Other names
Eyemax Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEROY MAXWELL SR. O.D M.PH (OPTOMETRIST)
(334) 872-2321
Entity
Organization
Contact information
Practice address
32510 HIGHWAY 43N, THOMASVILLE, AL 36784-1622
(334) 636-0016
(334) 636-9734
Mailing address
32510 HIGHWAY 43, THOMASVILLE, AL 36784-1611
(334) 636-0016
(334) 636-9734
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S435TA115
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000055528
—
AL
01
—
51055528
BLUE CROSS
AL
Enumeration date
01/26/2007
Last updated
10/25/2010
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