MEDICARE: DR. GREGORY A HIVELY O.D.

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	152W00000X	Optometrist	S945TA510	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619968385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A HIVELY O.D.

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-0640
Country	:	US
Telephone Number	:	205-640-2020
Fax Number	:	205-640-2025

Provider Business Practice Location Address
First Line	:	2603 MOODY PKWY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3027
Country	:	US
Telephone Number	:	205-640-2020
Fax Number	:	205-640-2025

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	12/19/2019

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