Provider Demographics
NPI:1013142587
Name:KEVIN W. NEAL, O.D., P.C.
Entity Type:Organization
Organization Name:KEVIN W. NEAL, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-520-7550
Mailing Address - Street 1:626 OLIVE ST SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5594
Mailing Address - Country:US
Mailing Address - Phone:256-775-0269
Mailing Address - Fax:256-775-6871
Practice Address - Street 1:626 OLIVE ST SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5594
Practice Address - Country:US
Practice Address - Phone:256-775-0269
Practice Address - Fax:256-775-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA02TA581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU87643Medicare UPIN