Healthcare Provider Details

I. General information

NPI: 1174783542
Provider Name (Legal Business Name): STEELE OPTOMETRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FOOTHILLS PLACE
CHELSEA AL
35043-8208
US

IV. Provider business mailing address

300 FOOTHILLS PLACE
CHELSEA AL
35043-8208
US

V. Phone/Fax

Practice location:
  • Phone: 205-678-2565
  • Fax: 205-678-3780
Mailing address:
  • Phone: 205-678-2565
  • Fax: 205-678-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberSA57TA650
License Number StateAL

VIII. Authorized Official

Name: MAGGIE GLASS
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-678-2565