Healthcare Provider Details

I. General information

NPI: 1164410387
Provider Name (Legal Business Name): RANDALL WALTER HOERTH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S HAMBRICK ST
ALBERTVILLE AL
35950-1624
US

IV. Provider business mailing address

PO BOX 860
ALBERTVILLE AL
35950-1624
US

V. Phone/Fax

Practice location:
  • Phone: 256-878-3024
  • Fax: 256-878-3049
Mailing address:
  • Phone: 256-878-3024
  • Fax: 256-878-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS370 TA048
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: