MEDICARE: DR. HAYDEN EVANS POWELL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	SA93TA669	AL

General Provider Information

NPI Number	:	1104840115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYDEN EVANS POWELL O.D.

Provider Business Mailing Address
First Line	:	2612 APOLLO CIR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-2305
Country	:	US
Telephone Number	:	205-915-0959
Fax Number	:	205-444-0317

Provider Business Practice Location Address
First Line	:	5561 GROVE BLVD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-4600
Country	:	US
Telephone Number	:	205-987-6759
Fax Number	:	205-444-0317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/19/2012

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