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General NPI Number Information
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NPI Number | 1487084612
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Entity Type | Organization
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Legal Business Name | AYESHA KIDD SENIOR EYECARE SERVICE LLC
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 5700 GRELOT RD APT # 925
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City | MOBILE
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State | AL
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Zip | 36609-3617
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Country | US
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Telephone | 205-835-5024
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 GRELOT RD APT # 925
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City | MOBILE
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State | AL
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Zip | 36609-3617
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Country | US
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Telephone | 205-835-5024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AYESHA KIDD
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Credential |
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Telephone | 205-835-5024
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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-C61-TA-904
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License Number State | AL
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