Provider Demographics
NPI:1679666176
Name:MENARD, JAMES DENIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DENIS
Last Name:MENARD
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 1:6500 AUDUBON SQ N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-6231
Mailing Address - Country:US
Mailing Address - Phone:693-486-4926
Mailing Address - Fax:
Practice Address - Street 1:12701 PADGETT SWITCH RD
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:AL
Practice Address - Zip Code:36544-4011
Practice Address - Country:US
Practice Address - Phone:251-824-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-276-TA-B68152W00000X
NH0731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M1157139OtherDEA #
M1157139OtherDEA #