Provider Demographics
NPI:1336364298
Name:AL H COVINGTON OD PA
Entity Type:Organization
Organization Name:AL H COVINGTON OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:HOOK
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-997-4489
Mailing Address - Street 1:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28380-2020
Mailing Address - Country:US
Mailing Address - Phone:910-997-4489
Mailing Address - Fax:910-895-7453
Practice Address - Street 1:101 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5221
Practice Address - Country:US
Practice Address - Phone:910-997-4489
Practice Address - Fax:910-895-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890913CMedicaid
NCCA7791OtherRAILROAD MEDICARE
NC890913CMedicaid
NCCA7791OtherRAILROAD MEDICARE