Provider Demographics
NPI:1649263773
Name:NEAL, KEVIN WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WAYNE
Last Name:NEAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:100 SAGE OAK LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-4016
Mailing Address - Country:US
Mailing Address - Phone:256-520-7550
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
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA02-TA-581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51504769OtherBCBSAL
ALU87643Medicare UPIN
AL51504769OtherBCBSAL