Provider Demographics
NPI:1811979982
Name:POOLE, JAMES HOWARD (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HOWARD
Last Name:POOLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1120 AIRPORT DR
Mailing Address - Street 2:SUITE104
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:SUITE104
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?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS641-TA-157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51095094OtherBLUE CROSS BLUE SHIELD
AL51095087OtherBLUE CROSS BLUE SHIELD
AL0348120001Medicare NSC
AL51095087OtherBLUE CROSS BLUE SHIELD