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General NPI Number Information
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NPI Number | 1346562436
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Entity Type | Individual
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Provider Name | S AMIR ALI TAVAKOLI ISFAHANI O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 11610 S MEMORIAL PKWY
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City | HUNTSVILLE
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State | AL
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Zip | 35803-2152
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Country | US
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Telephone | 256-881-3763
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Fax | 256-881-5327
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Provider Business Mailing Address
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Address Line | 1200 PRESIDENTS WAY SE
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City | HUNTSVILLE
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State | AL
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Zip | 35803-3673
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Country | US
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Telephone | 256-797-3606
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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-C19-TA-840
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License Number State | AL
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