Healthcare Provider Details

I. General information

NPI: 1487728218
Provider Name (Legal Business Name): TUSCALOOSA OPHTHALMOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JACK WARNER PKWY NE STE B1
TUSCALOOSA AL
35404-5715
US

IV. Provider business mailing address

535 JACK WARNER PKWY NE STE B1
TUSCALOOSA AL
35404-5715
US

V. Phone/Fax

Practice location:
  • Phone: 205-556-2121
  • Fax: 205-554-0152
Mailing address:
  • Phone: 205-556-2121
  • Fax: 205-554-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GIRA
Title or Position: CMO/AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 636-227-2600