Provider Demographics
NPI:1285812974
Name:LOUIS LADON SNELLGROVE
Entity type:Organization
Organization Name:LOUIS LADON SNELLGROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:LADON
Authorized Official - Last Name:SNELLGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-382-5571
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-0159
Mailing Address - Country:US
Mailing Address - Phone:334-382-5571
Mailing Address - Fax:334-383-9101
Practice Address - Street 1:400 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-2312
Practice Address - Country:US
Practice Address - Phone:334-382-5571
Practice Address - Fax:334-383-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS183TA227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059295Medicaid
AL000059295Medicaid