Healthcare Provider Details

I. General information

NPI: 1801421904
Provider Name (Legal Business Name): ALABAMA OCULOPLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ADAMS ST SE STE 130
HUNTSVILLE AL
35801-3751
US

IV. Provider business mailing address

910 ADAMS ST SE STE 130
HUNTSVILLE AL
35801-3751
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-6344
  • Fax: 256-265-7965
Mailing address:
  • Phone: 256-265-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH MIRELES JACOBS
Title or Position: OWNER
Credential: MD
Phone: 256-265-7863