MEDICARE: CECIL D PAVEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	N/A

General Provider Information

NPI Number	:	1568564169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECIL D PAVEY

Provider Business Mailing Address
First Line	:	PO BOX 346
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35046-0346
Country	:	US
Telephone Number	:	205-280-0064
Fax Number	:	205-280-0030

Provider Business Practice Location Address
First Line	:	700 7TH ST S
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35045-3778
Country	:	US
Telephone Number	:	205-280-0064
Fax Number	:	205-280-0030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/09/2007

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Directions to “ CECIL D PAVEY ” Practice Location

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