Healthcare Provider Details

I. General information

NPI: 1215135967
Provider Name (Legal Business Name): DR. BRIAN R. PETTIE EYECARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MONTCLAIR RD
IRONDALE AL
35210-2410
US

IV. Provider business mailing address

1600 MONTCLAIR RD
IRONDALE AL
35210-2410
US

V. Phone/Fax

Practice location:
  • Phone: 205-951-3268
  • Fax: 205-719-4021
Mailing address:
  • Phone: 205-951-3268
  • Fax: 205-719-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-A54-TA-634
License Number StateAL

VIII. Authorized Official

Name: DR. BRIAN ROLAND PETTIE
Title or Position: OPTOMETRIST
Credential: OD
Phone: 205-951-3268