Healthcare Provider Details

I. General information

NPI: 1750470902
Provider Name (Legal Business Name): PAUL JOSEPH SCHIFANELLA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5358A HIGHWAY 17
HELENA AL
35080-3604
US

IV. Provider business mailing address

5358A HIGHWAY 17
HELENA AL
35080-3604
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-7577
  • Fax: 205-664-7654
Mailing address:
  • Phone: 205-664-7577
  • Fax: 205-664-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSA44TA614
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: