Healthcare Provider Details

I. General information

NPI: 1285644666
Provider Name (Legal Business Name): FELTON PERRY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 UNIVERSITY BLVD HPB G080A
BIRMINGHAM AL
35294-0001
US

IV. Provider business mailing address

1716 UNIVERSITY BLVD HPB G080A
BIRMINGHAM AL
35294-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-2020
  • Fax: 205-934-6755
Mailing address:
  • Phone: 205-934-4748
  • Fax: 205-934-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS346TA314
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: