Healthcare Provider Details

I. General information

NPI: 1477526606
Provider Name (Legal Business Name): LINDA E SLADE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PROVIDENCE PARK DRIVE
MOBILE AL
36695-4617
US

IV. Provider business mailing address

601 PROVIDENCE PARK DRIVE
MOBILE AL
36695-4617
US

V. Phone/Fax

Practice location:
  • Phone: 251-650-1000
  • Fax: 251-650-1010
Mailing address:
  • Phone: 251-650-1000
  • Fax: 251-650-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-855-TA-414
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: