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General NPI Number Information
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NPI Number | 1659677789
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Entity Type | Organization
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Legal Business Name | EYE CENTER OF ALABAMA PC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 20 MEDICAL CENTER DR 100
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City | JASPER
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State | AL
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Zip | 35501-3425
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Country | US
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Telephone | 205-221-4705
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Fax |
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Provider Business Mailing Address
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Address Line | 20 MEDICAL CENTER DR 100
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City | JASPER
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State | AL
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Zip | 35501-3425
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Country | US
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Telephone | 205-221-4705
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAYLOR A MOSLEY
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Credential | MD
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Telephone | 205-221-4705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 28293
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License Number State | AL
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