Provider Demographics
NPI:1770616989
Name:JOSHUA DRIVER PC
Entity type:Organization
Organization Name:JOSHUA DRIVER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:334-493-6600
Mailing Address - Street 1:604 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1600
Mailing Address - Country:US
Mailing Address - Phone:334-493-6600
Mailing Address - Fax:334-493-2991
Practice Address - Street 1:604 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1600
Practice Address - Country:US
Practice Address - Phone:334-493-6600
Practice Address - Fax:334-493-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912170Medicaid
AL051552155Medicare ID - Type Unspecified
AL4588240001Medicare NSC
AL529912170Medicaid