=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609053263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN VISION AND HEARING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2008
-----------------------------------------------------
Last Update Date | 03/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 N ELM AVE
-----------------------------------------------------
City | SYLACAUGA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35150-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-245-3171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 N ELM AVE
-----------------------------------------------------
City | SYLACAUGA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35150-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-245-3171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ADAM WALLY SHAIKH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-391-6606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S-A39-TA-599
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------