Provider Demographics
NPI:1073799789
Name:JIM CLAY OPTICIAN
Entity Type:Organization
Organization Name:JIM CLAY OPTICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VPRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-933-8615
Mailing Address - Street 1:4414 GARY AV
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-1336
Mailing Address - Country:US
Mailing Address - Phone:205-786-0354
Mailing Address - Fax:
Practice Address - Street 1:1705 10TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3607
Practice Address - Country:US
Practice Address - Phone:205-933-8615
Practice Address - Fax:205-933-1769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JIM CLAY OPTICIAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL08000003332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0138290005Medicare PIN