Healthcare Provider Details

I. General information

NPI: 1891463055
Provider Name (Legal Business Name): OXFORD EYE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CHOCCOLOCCO ST STE C
OXFORD AL
36203-1225
US

IV. Provider business mailing address

PO BOX 970
ANNISTON AL
36202-0970
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENT KEYS
Title or Position: PHYSICIAN MANAGER
Credential: MD
Phone: 256-831-2040