Healthcare Provider Details

I. General information

NPI: 1679166409
Provider Name (Legal Business Name): PATHWAY EYE HUNTSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WHITESBURG DR SW
HUNTSVILLE AL
35802-3006
US

IV. Provider business mailing address

PO BOX 1189
ATHENS AL
35612-1189
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-8058
  • Fax:
Mailing address:
  • Phone: 256-233-2393
  • Fax: 256-233-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD DAVIS
Title or Position: PRESIDENT
Credential: OD
Phone: 256-233-2393