Healthcare Provider Details

I. General information

NPI: 1053396465
Provider Name (Legal Business Name): FRED B SETZER JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WEST LAKESHORE DRIVE
BIRMINGHAM AL
35209-7271
US

IV. Provider business mailing address

324C EDWARDS LAKE PARKWAY SUITE 100
BIRMINGHAM AL
35235-3218
US

V. Phone/Fax

Practice location:
  • Phone: 205-941-2020
  • Fax: 205-397-4190
Mailing address:
  • Phone: 205-949-2020
  • Fax: 205-949-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS364TA082
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: