Provider Demographics
NPI:1164598215
Name:TILLMAN, JAMES H JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:TILLMAN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1226
Mailing Address - Country:US
Mailing Address - Phone:334-222-2020
Mailing Address - Fax:
Practice Address - Street 1:1860 E THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36421-2404
Practice Address - Country:US
Practice Address - Phone:334-222-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS620TA088152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531187OtherBCBS PROVIDER ID
ALT69089Medicare UPIN