=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427936582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLACK WARRIOR OPHTHALMOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 JACK WARNER PKWY NE STE B1
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35404-5715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-349-3366
-----------------------------------------------------
Fax | 205-561-0660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 JACK WARNER PKWY NE STE B1 SUITE B-1
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35404-5715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-349-3366
-----------------------------------------------------
Fax | 205-561-0660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | ERNEST V JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 205-349-3366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------