=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467877803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT KABIR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2014
-----------------------------------------------------
Last Update Date | 02/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 JOHN AVE SE
-----------------------------------------------------
City | ATTALLA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35954-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-458-8118
-----------------------------------------------------
Fax | 256-538-5662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 JOHN AVE SE
-----------------------------------------------------
City | ATTALLA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35954-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-458-8118
-----------------------------------------------------
Fax | 256-538-5662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OPTOMETRIST
-----------------------------------------------------
Name | DR. JANAKKUMAR VIJAYKUMAR PATEL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 256-458-8118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S-D16-TA-964
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------