Provider Demographics
NPI:1083899405
Name:RANDALL W HOERTH OD PC
Entity Type:Organization
Organization Name:RANDALL W HOERTH OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOERTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-878-3024
Mailing Address - Street 1:P.O. BOX 860
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1624
Mailing Address - Country:US
Mailing Address - Phone:256-878-3024
Mailing Address - Fax:256-878-3025
Practice Address - Street 1:200 HAMBRICK STREET
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1624
Practice Address - Country:US
Practice Address - Phone:256-878-3024
Practice Address - Fax:256-878-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALTA048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4942860001Medicare NSC