Provider Demographics
NPI:1649252073
Name:ECHOLS, CLYDE G (OD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:G
Last Name:ECHOLS
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 1:2525 CENTER POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-2548
Mailing Address - Country:US
Mailing Address - Phone:205-854-6080
Mailing Address - Fax:205-856-2036
Practice Address - Street 1:2525 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-2548
Practice Address - Country:US
Practice Address - Phone:205-854-6080
Practice Address - Fax:205-856-2036
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS367TA032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE717Medicare PIN
ALT69194Medicare UPIN
AL1074080014Medicare NSC