MEDICARE: DR. DARRELL SCOTT PRESTRIDGE DO

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	207W00000X	Ophthalmology Physician	D0502	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	515-33912	OTHER	AL	BC BS OF AL

General Provider Information

NPI Number	:	1376543801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRELL SCOTT PRESTRIDGE DO

Provider Business Mailing Address
First Line	:	PO BOX 531326
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35253-1326
Country	:	US
Telephone Number	:	205-621-3437
Fax Number	:	205-621-8550

Provider Business Practice Location Address
First Line	:	2122 OLD MONTGOMERY HWY
Second Line	:
City	:	PELHAM
State	:	AL
Zip	:	35124-1138
Country	:	US
Telephone Number	:	205-621-3437
Fax Number	:	205-621-8550

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	12/01/2015

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