Healthcare Provider Details

I. General information

NPI: 1114998812
Provider Name (Legal Business Name): MORRI COULTER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WHITESBURG DR S
HUNTSVILLE AL
35802-3006
US

IV. Provider business mailing address

8200 WHITESBURG DRIVE S
HUNTSVILLE AL
35802-3006
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-8058
  • Fax:
Mailing address:
  • Phone: 256-880-8058
  • Fax: 256-880-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-595-TA-298
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS595TA298
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: