Healthcare Provider Details

I. General information

NPI: 1245299866
Provider Name (Legal Business Name): BRIAN W ROBERTS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 HIGHWAY 31
CALERA AL
35040-5154
US

IV. Provider business mailing address

5100 HIGHWAY 31
CALERA AL
35040-5154
US

V. Phone/Fax

Practice location:
  • Phone: 205-668-2633
  • Fax: 205-668-4269
Mailing address:
  • Phone: 205-668-2633
  • Fax: 205-668-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS991-TA563
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: