Provider Demographics
NPI:1477164507
Name:JOSHUA DRIVER PC
Entity Type:Organization
Organization Name:JOSHUA DRIVER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-493-6600
Mailing Address - Street 1:961 ALABAMA HIGHWAY 203
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-4228
Mailing Address - Country:US
Mailing Address - Phone:334-897-2142
Mailing Address - Fax:334-897-3632
Practice Address - Street 1:961 ALABAMA HIGHWAY 203
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-4228
Practice Address - Country:US
Practice Address - Phone:334-897-2142
Practice Address - Fax:334-897-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty