Organization
DARYL G. CUSTRED, O.D., L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARYL GLEN CUSTRED OD (MANAGER)
(205) 221-3721
Entity
Organization
Contact information
Practice address
1499 N AIRPORT RD, JASPER, AL 35504-8882
(205) 221-3721
(205) 221-2748
Mailing address
1499 N AIRPORT RD, JASPER, AL 35504-8882
(205) 221-3721
(205) 221-2748
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-505-TA-126
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103021
ALABAMA MEDICAID
AL
01
—
DN9352
RAILROAD MEDICARE
AL
Enumeration date
01/28/2008
Last updated
11/14/2010
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