Healthcare Provider Details

I. General information

NPI: 1639289663
Provider Name (Legal Business Name): VERONICA OLTMANNS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE S SUITE 501
BIRMINGHAM AL
35205-3410
US

IV. Provider business mailing address

1201 11TH AVE S SUITE 501
BIRMINGHAM AL
35205-3410
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-0930
  • Fax: 205-930-9050
Mailing address:
  • Phone: 205-930-0930
  • Fax: 205-930-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0601800197
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR-191-TA-865
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: