Provider Demographics
NPI:1154497238
Name:MONTGOMERY OPTOMETRIC CLINIC
Entity Type:Organization
Organization Name:MONTGOMERY OPTOMETRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:CHERNAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-271-2020
Mailing Address - Street 1:5783 CARMICHAEL PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2353
Mailing Address - Country:US
Mailing Address - Phone:334-271-2020
Mailing Address - Fax:334-271-2042
Practice Address - Street 1:5783 CARMICHAEL PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2353
Practice Address - Country:US
Practice Address - Phone:334-271-2020
Practice Address - Fax:334-271-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL015498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTIN
AL=========OtherTIN