Healthcare Provider Details

I. General information

NPI: 1720288632
Provider Name (Legal Business Name): MONTGOMERY EYE PHYSICIANS P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 ZELDA RD
MONTGOMERY AL
36106-2694
US

IV. Provider business mailing address

2752 ZELDA RD
MONTGOMERY AL
36106-2694
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-3804
  • Fax: 334-270-3375
Mailing address:
  • Phone: 334-365-5643
  • Fax: 334-365-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CANDICE B DAVIS
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 916-990-7590