Healthcare Provider Details

I. General information

NPI: 1053167239
Provider Name (Legal Business Name): JODIE FARNETTI POPE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 PIERSON AVE # 2332
CENTREVILLE AL
35042-2919
US

IV. Provider business mailing address

223 PIERSON AVE # 2332
CENTREVILLE AL
35042-2919
US

V. Phone/Fax

Practice location:
  • Phone: 205-926-4816
  • Fax:
Mailing address:
  • Phone: 205-926-4816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-F34-TA-D28
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: