Provider Demographics
NPI:1437142387
Name:HORNSBY, JOHN E (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:HORNSBY
Suffix:
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 1:2800 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2040
Mailing Address - Country:US
Mailing Address - Phone:334-793-2211
Mailing Address - Fax:
Practice Address - Street 1:2826 ROSS CLARK CIR STE 102
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2017
Practice Address - Country:US
Practice Address - Phone:334-793-2633
Practice Address - Fax:334-794-1626
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-584-TA-252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL282355Medicaid
ALAL0584OtherEYEMED
AL29447OtherSPECTERA
AL55623OtherDAVIS VISION
AL000058183Medicaid
AL51058183OtherBCBS
AL55623OtherDAVIS VISION
AL000058183Medicaid
AL0380960001Medicare NSC
T68946Medicare UPIN
P00660996Medicare PIN
AL410010622Medicare PIN