Provider Demographics
NPI:1578898557
Name:TYSON, JOANN MEADOWS (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:MEADOWS
Last Name:TYSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AVERY DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36205-3606
Mailing Address - Country:US
Mailing Address - Phone:256-225-1689
Mailing Address - Fax:
Practice Address - Street 1:5560 MCCLELLAN BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36206-1664
Practice Address - Country:US
Practice Address - Phone:256-820-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C04-TA-823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist