Individual
MR. ANDREW LEROY MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2826 ROSS CLARK CIR STE 102, DOTHAN, AL 36301-2017
(334) 793-2633
(334) 794-1626
Mailing address
2800 ROSS CLARK CIR, DOTHAN, AL 36301-2040
(334) 793-2211
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S547TA203
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059847
—
AL
01
—
051059847
BCBS
AL
Enumeration date
11/07/2005
Last updated
10/26/2022
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