Provider Demographics
NPI:1962694018
Name:CHILTON COUNTY OPTICAL INC
Entity type:Organization
Organization Name:CHILTON COUNTY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-280-0064
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35046
Mailing Address - Country:US
Mailing Address - Phone:205-280-0064
Mailing Address - Fax:205-280-0030
Practice Address - Street 1:700 7TH ST S
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045
Practice Address - Country:US
Practice Address - Phone:205-280-0064
Practice Address - Fax:205-280-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51500749OtherBLUE CROSS
AL924787OtherBLOCK VISION
AL009954170Medicaid
AL009954170Medicaid
AL0955920001Medicare NSC