Provider Demographics
NPI:1508936014
Name:ROY, P. DUNCAN JR (OD)
Entity Type:Individual
Prefix:
First Name:P. DUNCAN
Middle Name:
Last Name:ROY
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 J
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-0510
Mailing Address - Country:US
Mailing Address - Phone:256-378-5507
Mailing Address - Fax:256-378-5325
Practice Address - Street 1:34011 US HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-2128
Practice Address - Country:US
Practice Address - Phone:256-378-5507
Practice Address - Fax:256-378-5325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-471-TA-079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631019335OtherUNITED HEALTHCARE
KY631019335OtherHUMANA DENTAL
AL510-59662OtherBLUE CROSS
AL102I413417OtherMEDICARE ID
AL000059662Medicaid
AL000059662OtherMEDICARE
AL000059662Medicaid