Healthcare Provider Details

I. General information

NPI: 1841434826
Provider Name (Legal Business Name): OXFORD EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CHOCCOLOCCO ST
OXFORD AL
36203-1225
US

IV. Provider business mailing address

333 E CHOCCOLOCCO ST
OXFORD AL
36203-1225
US

V. Phone/Fax

Practice location:
  • Phone: 256-831-2040
  • Fax: 256-831-2716
Mailing address:
  • Phone: 256-831-2040
  • Fax: 256-831-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-540-TA-102
License Number StateAL

VIII. Authorized Official

Name: RONALD L ADERHOLT
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 256-831-2040