Healthcare Provider Details

I. General information

NPI: 1043313661
Provider Name (Legal Business Name): LANDRETH & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 1ST STREET
REFORM AL
35481
US

IV. Provider business mailing address

PO BOX 59 311 1ST STREET
REFORM AL
35481-0059
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-8200
  • Fax: 205-375-8234
Mailing address:
  • Phone: 205-375-8200
  • Fax: 205-375-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS914TA467
License Number StateAL

VIII. Authorized Official

Name: MR. STEVEN RODNEY LANDRETH
Title or Position: PRESIDENT
Credential: OD
Phone: 205-375-8200