Healthcare Provider Details

I. General information

NPI: 1285856542
Provider Name (Legal Business Name): ANDREA BEAVERS HUDSON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 7TH AVE S STE 104
BIRMINGHAM AL
35233-2927
US

IV. Provider business mailing address

621 EASTWOOD PL
VESTAVIA AL
35216-1923
US

V. Phone/Fax

Practice location:
  • Phone: 205-447-6774
  • Fax: --
Mailing address:
  • Phone: 205-447-6774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-881-TA-462
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberS-881-TA-462
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: