Healthcare Provider Details

I. General information

NPI: 1144011891
Provider Name (Legal Business Name): LEAH CAELYN GRANT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 UNIVERSITY BLVD G080A
BIRMINGHAM AL
35294-0010
US

IV. Provider business mailing address

1716 UNIVERSITY BLVD G080A
BIRMINGHAM AL
35294-0010
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-2020
  • Fax: 205-934-6755
Mailing address:
  • Phone: 205-975-2020
  • Fax: 205-934-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT-263-TA-D52
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: