Healthcare Provider Details

I. General information

NPI: 1598867137
Provider Name (Legal Business Name): ANTHONY RILEY AUSTIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 MCFARLAND BLVD
NORTHPORT AL
35476-3539
US

IV. Provider business mailing address

8204 LAKE SHERWOOD CIR
NORTHPORT AL
35473-8425
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-7859
  • Fax: 205-333-7869
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS960TA520
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: