Healthcare Provider Details

I. General information

NPI: 1437194867
Provider Name (Legal Business Name): RETINA SPECIALISTS OF ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 UNIVERSITY BLVD STE 101
BIRMINGHAM AL
35233-2313
US

IV. Provider business mailing address

2208 UNIVERSITY BLVD STE 101
BIRMINGHAM AL
35233-2313
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2625
  • Fax: 205-558-2567
Mailing address:
  • Phone: 205-933-2625
  • Fax: 205-558-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MATHEW R SAPP
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-933-2625