Healthcare Provider Details

I. General information

NPI: 1518410513
Provider Name (Legal Business Name): KACEY CAPPS CILIMBERG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 LIBERTY PKWY STE 103
VESTAVIA AL
35242-7670
US

IV. Provider business mailing address

8011 LIBERTY PKWY STE 103
VESTAVIA AL
35242-7670
US

V. Phone/Fax

Practice location:
  • Phone: 205-506-2200
  • Fax: 205-506-2257
Mailing address:
  • Phone: 615-818-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR-255-TA-B03
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: