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General NPI Number Information
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NPI Number | 1144514068
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Entity Type | Individual
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Provider Name | LORI ALYSE JASPER O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 2226 1ST AVE S #103
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City | BIRMINGHAM
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State | AL
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Zip | 35233-2333
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Country | US
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Telephone | 205-222-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 201 DUNROBIN CV
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City | PELHAM
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State | AL
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Zip | 35124-6286
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Country | US
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Telephone | 205-222-5117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-C60-TA-898
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License Number State | AL
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