Provider Demographics
NPI:1740261601
Name:CHAMPION, ERNEST JONATHAN (OD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:JONATHAN
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1120 AIRPORT DR
Mailing Address - Street 2:STE 104
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3436
Mailing Address - Country:US
Mailing Address - Phone:256-329-8400
Mailing Address - Fax:256-329-8200
Practice Address - Street 1:1120 AIRPORT DR
Practice Address - Street 2:STE 104
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3436
Practice Address - Country:US
Practice Address - Phone:256-329-8400
Practice Address - Fax:256-329-8200
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALS-908 TA 463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL95104OtherBLUE CROSS PIN #
ALU85424Medicare UPIN