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General NPI Number Information
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NPI Number | 1770735417
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Entity Type | Organization
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Legal Business Name | RED MOUNTAIN EYECARE, P.C.
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 1919 28TH AVE S STE 117
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City | BIRMINGHAM
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State | AL
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Zip | 35209-2684
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Country | US
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Telephone | 205-879-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 28TH AVE S STE 117
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City | BIRMINGHAM
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State | AL
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Zip | 35209-2684
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Country | US
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Telephone | 205-879-6300
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | ARMAND GAGNON
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Credential | OD
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Telephone | 205-879-6300
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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 | AL566
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License Number State | AL
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