Phillip B Tickner OD & Associates LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

SB65TA769 Issued in AL

Legal business name

PHILLIP B TICKNER OD & ASSOCIATES LLC

Practice address

8551 Whitfield Ave
Leeds, AL 35094-7560

Phone

(205) 699-0719

Fax

(205) 699-0722

NPI assigned

Nov 6, 2009

Organization subpart

No

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

Authorized official

Name

Phillip Bryan Tickner, ODNPI 1124211990

Title

OD

Phone

(205) 919-0671

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Phillip Bryan Tickner, O.D.

  • Optometrist
  • Leeds, AL
  • NPI 1124211990
  Medicare reassignment NPD Authorized official
• Johnna Leigh Headley Blackerby, O.D.

  • Optometrist
  • Columbiana, AL
  • NPI 1730475682
  NPD (past)

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274140800000",
    "number": "1578890885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 ANDERSON CIR",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351731001",
            "telephone_number": "205-919-0671",
            "fax_number": "205-739-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8551 WHITFIELD AVE",
            "city": "LEEDS",
            "state": "AL",
            "postal_code": "350947560",
            "telephone_number": "205-699-0719",
            "fax_number": "205-699-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIP B TICKNER OD & ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2010-05-18",
        "status": "A",
        "authorized_official_last_name": "TICKNER",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "OD",
        "authorized_official_telephone_number": "205-919-0671",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AL",
            "license": "SB65TA769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patterson Pharmacy Inc
• Andrew Parker Patterson, PT, DPT
• Savannah Jo Payne
• Peterson Dental, LLC
• Eric Warren Peterson, D.M.D.
• Princess Diane Pippen, CRNP-FNP-BC
• Jackson Pollard
• Ann Prendergast, RPH
• Jennifer Prentice, PHARM. D.
• Jason Brian Pulliam, OD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.