Healthcare Provider Details

I. General information

NPI: 1992807259
Provider Name (Legal Business Name): ALABAMA VISION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 MONTCLAIR RD SUITE 100
BIRMINGHAM AL
35213-1966
US

IV. Provider business mailing address

790 MONTCLAIR RD SUITE 100
BIRMINGHAM AL
35213-1966
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-3911
  • Fax: 205-592-3537
Mailing address:
  • Phone: 205-592-3911
  • Fax: 205-592-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH GIRA
Title or Position: CMO/AUTHORIZED OFFICIAL
Credential: MD
Phone: 636-227-2600