=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720263072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JIM CLAY OPTICIAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2008
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 833 PRINCETON AV SW SUITE 110
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35211-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-786-5239
-----------------------------------------------------
Fax | 205-786-5238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 833 PRINCETON AVE SW SUITE 110
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35211-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-786-5239
-----------------------------------------------------
Fax | 205-786-5238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | V PRES
-----------------------------------------------------
Name | MR. JAMES NORMAN CLAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-933-8615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 08000002
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------