Healthcare Provider Details

I. General information

NPI: 1740167378
Provider Name (Legal Business Name): VICTORIA WEEKS DESHAZO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 EDWARDS LAKE PKWY STE 100
TRUSSVILLE AL
35235-3128
US

IV. Provider business mailing address

1229 CONCORD AVE
BIRMINGHAM AL
35213-2142
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-2020
  • Fax:
Mailing address:
  • Phone: 334-248-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSF50TAD62
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: