Provider Demographics
NPI:1972679033
Name:DRIVER, JOSHUA JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JONATHAN
Last Name:DRIVER
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 1:604 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1600
Mailing Address - Country:US
Mailing Address - Phone:334-493-6600
Mailing Address - Fax:334-493-2991
Practice Address - Street 1:604 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1600
Practice Address - Country:US
Practice Address - Phone:334-493-6600
Practice Address - Fax:334-493-2991
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA25TA585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51511050OtherBLUE CROSS OF ALABAMA
AL529912170Medicaid
AL51511050OtherBLUE CROSS OF ALABAMA
AL051552155Medicare PIN
AL4588240001Medicare NSC