Provider Demographics
NPI:1922183722
Name:LANDRETH & ASSOCIATES INC
Entity Type:Organization
Organization Name:LANDRETH & ASSOCIATES INC
Other - Org Name:TUSCALOOSA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:LANDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-758-0242
Mailing Address - Street 1:1655 MCFARLAND BLVD N
Mailing Address - Street 2:SUITE 127
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2212
Mailing Address - Country:US
Mailing Address - Phone:205-758-0242
Mailing Address - Fax:205-758-0262
Practice Address - Street 1:3519 WATERMELON RD
Practice Address - Street 2:FAIRFAX PARK
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5174
Practice Address - Country:US
Practice Address - Phone:205-758-0242
Practice Address - Fax:205-758-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS 914 TA 467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCH9939OtherRAILROAD MEDICARE
AL529919580Medicaid
051500676OtherBCBS
051500676OtherBCBS
051500676Medicare PIN
ALCH9939OtherRAILROAD MEDICARE