=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689757510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RETINA CENTERS OF ALABAMA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 06/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2331 WHITESBURG DR S SUITE B&C
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-536-0505
-----------------------------------------------------
Fax | 256-536-0504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2331 WHITESBURG DR S SUITE B&C
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-536-0505
-----------------------------------------------------
Fax | 256-536-0504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMIE G SAUNDERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-536-0505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 16564
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------