Healthcare Provider Details

I. General information

NPI: 1275294217
Provider Name (Legal Business Name): CAALKEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 WARES FERRY RD
MONTGOMERY AL
36117
US

IV. Provider business mailing address

9033 WARES FERRY RD
MONTGOMERY AL
36117
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-7751
  • Fax: 334-460-0665
Mailing address:
  • Phone: 334-277-7751
  • Fax: 334-460-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CAMTU NGOC NGUYEN
Title or Position: MANAGER
Credential: O.D.
Phone: 334-322-2713