Selma Family Practice Optometry, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

S435TA115 Issued in AL

Legal business name

SELMA FAMILY PRACTICE OPTOMETRY, INC.

Doing business as

Eyemax Vision Center

Practice address

1502 Highway 80E
Suite a
Demopolis, AL 36732-0799

Phone

(334) 289-1008

Fax

(334) 289-1009

NPI assigned

Jan 24, 2007

Last updated

Jan 24, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Willie F Smith, MANAGER

Title

Optician

Phone

(334) 289-1008

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Eyemax Vision Center Doing business as

Tax ID family

Eyemax Vision Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Selma Family Practice Optometry, Inc.

  dba Eyemax Vision Center

  • Optometrist
  • Thomasville, AL
  • NPI 1891841599
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leroy Maxwell Sr., OD MPH

  • Optometrist
  • Selma, AL
  • NPI 1396758504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1104971803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 799",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367320799",
            "telephone_number": "334-289-1008",
            "fax_number": "334-289-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 HIGHWAY 80E",
            "address_2": "SUITE A",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367320799",
            "telephone_number": "334-289-1008",
            "fax_number": "334-289-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELMA FAMILY PRACTICE OPTOMETRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OPTICIAN",
        "authorized_official_telephone_number": "334-289-1008",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S435TA115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000055527",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51055527",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyemax Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Flexer Roy, CRNP, FNP
• RTG Medical
• Rural Health Medical Program, Inc (Demopolis Health Center)
• Mohammed Salehuddin, MD
• Kayla J Scott, CRNP
• Mary Juanita Shakes, LCSW
• Ellen Lewis Singleton, CRNP
• Southeast Cancer Network, Inc
• William Don Sprewell, PT
• Statewide Healthcare Services, Inc (Oxford Healthcare)

• Optometrist in Demopolis, AL
• Providers in Demopolis, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.