Provider Demographics
NPI:1720250988
Name:PURIFOY, JOHN WESLEY JR
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WESLEY
Last Name:PURIFOY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13261 AL HIGHWAY 91
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077-2816
Mailing Address - Country:US
Mailing Address - Phone:256-287-3315
Mailing Address - Fax:256-287-2475
Practice Address - Street 1:13261 AL HIGHWAY 91
Practice Address - Street 2:
Practice Address - City:HANCEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35077-2816
Practice Address - Country:US
Practice Address - Phone:256-287-3315
Practice Address - Fax:256-287-2475
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL227356156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0943470001Medicare NSC