Provider Demographics
NPI:1043313661
Name:LANDRETH & ASSOCIATES INC
Entity Type:Organization
Organization Name:LANDRETH & ASSOCIATES INC
Other - Org Name:PICKENS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:LANDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-375-8200
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:311 1ST STREET
Mailing Address - City:REFORM
Mailing Address - State:AL
Mailing Address - Zip Code:35481-0059
Mailing Address - Country:US
Mailing Address - Phone:205-375-8200
Mailing Address - Fax:205-375-8234
Practice Address - Street 1:311 1ST STREET
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481
Practice Address - Country:US
Practice Address - Phone:205-375-8200
Practice Address - Fax:205-375-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS914TA467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009961460Medicaid
AL051500677OtherBCBS
AL009961460Medicaid
AL4579610001Medicare NSC
AL051500677Medicare ID - Type Unspecified