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General NPI Number Information
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NPI Number | 1386747483
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Entity Type | Individual
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Provider Name | CHARLES A BROCK OD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 790 MONTGOMERY HWY STE 110
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City | VESTAVIA HILLS
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State | AL
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Zip | 35216-1873
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Country | US
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Telephone | 205-823-4555
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Fax | 205-823-1881
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Provider Business Mailing Address
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Address Line | 2473 HACKWORTH RD
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City | BIRMINGHAM
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State | AL
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Zip | 35214-1909
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Country | US
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Telephone | 205-798-3033
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Fax | 205-798-3647
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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-524-TA-199
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License Number State | AL
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