Healthcare Provider Details

I. General information

NPI: 1396735593
Provider Name (Legal Business Name): MARTIN HABEL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CHURCH ST NW
RAINSVILLE AL
35986-0609
US

IV. Provider business mailing address

94 CHURCH ST NW PO BOX 609
RAINSVILLE AL
35986-0609
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-6386
  • Fax: 256-638-7360
Mailing address:
  • Phone: 256-638-6386
  • Fax: 256-638-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS0415TA042
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: