Healthcare Provider Details

I. General information

NPI: 1952010423
Provider Name (Legal Business Name): UAB GRADS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 US HIGHWAY 331 S STE 1
DEFUNIAK SPRINGS FL
32435-3307
US

IV. Provider business mailing address

113 N PALAFOX ST
PENSACOLA FL
32502-4838
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-5514
  • Fax: 850-892-0189
Mailing address:
  • Phone: 850-542-5133
  • Fax: 850-290-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KATIE SPEAR
Title or Position: OWNER
Credential: OD
Phone: 850-542-5133