Provider Demographics
NPI:1578696639
Name:LAY, GARRY LEE (OPTICAN)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:LEE
Last Name:LAY
Suffix:
Gender:M
Credentials:OPTICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2903
Mailing Address - Country:US
Mailing Address - Phone:256-739-3651
Mailing Address - Fax:
Practice Address - Street 1:115 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2903
Practice Address - Country:US
Practice Address - Phone:256-739-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1248830001Medicare NSC