Provider Demographics
NPI:1689653875
Name:FEW, GARY C (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:C
Last Name:FEW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1813 KRESS STREET NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3601
Mailing Address - Country:US
Mailing Address - Phone:256-739-3605
Mailing Address - Fax:256-734-8681
Practice Address - Street 1:1813 KRESS STREET NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3601
Practice Address - Country:US
Practice Address - Phone:256-739-3605
Practice Address - Fax:256-734-8681
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-726-TA-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU20354Medicare UPIN
AL5527030001Medicare NSC
AL051512914Medicare ID - Type UnspecifiedCULLMAN MEDICARE NUMBER