Healthcare Provider Details

I. General information

NPI: 1851496087
Provider Name (Legal Business Name): TUSCALOOSA OPHTHALMOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JACK WARNER PKWY NE SUITE B-1
TUSCALOOSA AL
35404-5751
US

IV. Provider business mailing address

535 JACK WARNER PKWY NE SUITE B-1
TUSCALOOSA AL
35404-5751
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 TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAL

VIII. Authorized Official

Name: ERNEST VAN JOHNSON
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 205-556-2121