MEDICARE: LANDRETH & ASSOCIATES INC

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 914 TA 467	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH9939	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	051500676	OTHER		BCBS

General Provider Information

NPI Number	:	1922183722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDRETH & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1655 MCFARLAND BLVD N
Second Line	:	SUITE 127
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-2212
Country	:	US
Telephone Number	:	205-758-0242
Fax Number	:	205-758-0262

Provider Business Practice Location Address
First Line	:	3519 WATERMELON RD
Second Line	:	FAIRFAX PARK
City	:	NORTHPORT
State	:	AL
Zip	:	35473-5174
Country	:	US
Telephone Number	:	205-758-0242
Fax Number	:	205-758-0262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN RODNEY LANDRETH
Credential	:	OD
Telephone Number	:	205-758-0242

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	03/18/2009

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Directions to “LANDRETH & ASSOCIATES INC ” Practice Location

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