MEDICARE: MRS. RICA P MCROY OD

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	S-847-TA-353	AL
2	152W00000X	Optometrist	S847TA353	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	512-9179	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1356312045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RICA P MCROY OD

Provider Business Mailing Address
First Line	:	4030 BALMORAL DR SW STE A
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-6402
Country	:	US
Telephone Number	:	256-801-0099
Fax Number	:	256-533-1369

Provider Business Practice Location Address
First Line	:	4030 BALMORAL DR SW STE A
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801
Country	:	US
Telephone Number	:	256-801-0099
Fax Number	:	256-533-1369

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	11/22/2023

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