Healthcare Provider Details

I. General information

NPI: 1235105677
Provider Name (Legal Business Name): BARRY RAYFORD BASDEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 COX CREEK PKWY
FLORENCE AL
35630-1001
US

IV. Provider business mailing address

711 COX CREEK PKWY
FLORENCE AL
35630-1001
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-3139
  • Fax: 256-767-7374
Mailing address:
  • Phone: 256-766-3139
  • Fax: 256-767-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-722-TA-009
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: