Healthcare Provider Details

I. General information

NPI: 1235624131
Provider Name (Legal Business Name): CRYSTAL MAHARREY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL MEGAN HOWELL

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

216 GAYLE DR
BIRMINGHAM AL
35217-1921
US

V. Phone/Fax

Practice location:
  • Phone: 205-542-9829
  • Fax:
Mailing address:
  • Phone: 205-542-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberS-E12
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-E12
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: