MEDICARE: DR. FRANK J SPALLA, JR. O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	S-401-TA-083	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S-401-TA-083	OTHER	AL	AL BOARD OF OPTOMETRY

General Provider Information

NPI Number	:	1053386052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK J SPALLA, JR. O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1310
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-6102
Country	:	US
Telephone Number	:	205-661-2080
Fax Number	:	205-661-2085

Provider Business Practice Location Address
First Line	:	4800 WHITESBURG DR S
Second Line	:	SUITE 26
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-1698
Country	:	US
Telephone Number	:	256-213-2020
Fax Number	:	256-882-9396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. FRANK J SPALLA, JR. O.D.” Practice Location

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