Healthcare Provider Details

I. General information

NPI: 1528150851
Provider Name (Legal Business Name): RETINA SPECIALISTS OF WEST ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HARGROVE RD E
TUSCALOOSA AL
35401-3751
US

IV. Provider business mailing address

2101 HIGHLAND AVE S STE 350
BIRMINGHAM AL
35205-4009
US

V. Phone/Fax

Practice location:
  • Phone: 205-343-0003
  • Fax: 205-343-0029
Mailing address:
  • Phone: 205-558-2525
  • Fax: 205-558-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL WAYNE TAYLOR JR.
Title or Position: MEMBER
Credential: M.D.
Phone: 205-343-0003