Healthcare Provider Details

I. General information

NPI: 1588541114
Provider Name (Legal Business Name): SAMUEL HASKINS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAMMY HASKINS OD

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 COLONNADE PKWY STE 101
BIRMINGHAM AL
35243-2382
US

IV. Provider business mailing address

PO BOX 59449
BIRMINGHAM AL
35259-9449
US

V. Phone/Fax

Practice location:
  • Phone: 833-733-8742
  • Fax: 205-634-5640
Mailing address:
  • Phone: 833-733-8742
  • Fax: 205-634-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-F63-TA-D69
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: