Healthcare Provider Details

I. General information

NPI: 1164434536
Provider Name (Legal Business Name): DRS. COULTER, MCROY & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WHITESBURG DRIVE SOUTH
HUNTSVILLE AL
35802
US

IV. Provider business mailing address

8200 WHITESBURG DRIVE SOUTH
HUNTSVILLE AL
35802
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-8058
  • Fax: 256-880-1277
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 TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR151TA719
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS595 TA 298
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-847-TA-353
License Number StateAL

VIII. Authorized Official

Name: MONA MCROY VINES
Title or Position: OFFICE COMPTROLLER
Credential: CPO
Phone: 256-880-8058