Healthcare Provider Details

I. General information

NPI: 1265817902
Provider Name (Legal Business Name): AMIE MARSH O. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE MIRANDA GAITHER

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 CHRISTINE AVE
ANNISTON AL
36207-5709
US

IV. Provider business mailing address

700 18TH ST S
BIRMINGHAM AL
35233-1856
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-0371
  • Fax: 256-236-4181
Mailing address:
  • Phone: 918-444-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2860
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR-250-TA-A63
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: