Healthcare Provider Details

I. General information

NPI: 1851336226
Provider Name (Legal Business Name): RETINA SPECIALISTS OF ALABAMA IN MONTGOMERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 NORMANDIE DR SUITE 314
MONTGOMERY AL
36111-2732
US

IV. Provider business mailing address

1201 11TH AVENUE SOUTH SUITE 300
BIRMINGHAM AL
35205
US

V. Phone/Fax

Practice location:
  • Phone: 334-263-0105
  • Fax: 334-264-4386
Mailing address:
  • Phone: 205-933-2625
  • Fax: 205-558-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PAIGE MASSEY
Title or Position: MANAGING PHYSCIAN
Credential: M.D.
Phone: 334-263-0105