MEDICARE: FRED B SETZER JR. OD

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	S364TA082	AL

General Provider Information

NPI Number	:	1053396465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED B SETZER JR. OD

Provider Business Mailing Address
First Line	:	324C EDWARDS LAKE PARKWAY
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3218
Country	:	US
Telephone Number	:	205-949-2020
Fax Number	:	205-949-1400

Provider Business Practice Location Address
First Line	:	ONE WEST LAKESHORE DRIVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-7271
Country	:	US
Telephone Number	:	205-941-2020
Fax Number	:	205-397-4190

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	01/14/2008

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