=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871791897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTGOMERY EYE PHYSICIANS P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2752 ZELDA RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106-2694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-481-2800
-----------------------------------------------------
Fax | 334-270-3375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2752 ZELDA RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106-2694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-481-2800
-----------------------------------------------------
Fax | 334-270-3375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF REVENUE OFFICER
-----------------------------------------------------
Name | CANDICE B DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-990-7590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------