Healthcare Provider Details

I. General information

NPI: 1720410129
Provider Name (Legal Business Name): BRITTANY JACKSON LOVE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 10TH AVE S STE 201
BIRMINGHAM AL
35205-1623
US

IV. Provider business mailing address

2100 DEVEREUX CIR STE 100
VESTAVIA AL
35243-2558
US

V. Phone/Fax

Practice location:
  • Phone: 828-687-7500
  • Fax: 828-687-7333
Mailing address:
  • Phone: 205-933-2340
  • Fax: 205-933-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-D08-TA-952
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1826
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2414
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: