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General NPI Number Information
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NPI Number | 1104834381
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Entity Type | Individual
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Provider Name | MATTHEW DANIEL BOX O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 1501 SKYLAND BLVD E
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City | TUSCALOOSA
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State | AL
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Zip | 35405-4231
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Country | US
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Telephone | 205-750-8529
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71588
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City | TUSCALOOSA
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State | AL
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Zip | 35407-1588
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Country | US
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Telephone | 205-427-8857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | SA06TA553
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License Number State | AL
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