MEDICARE: SAMANTHA CALHOUN 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	S-F44-TA-D41	AL

General Provider Information

NPI Number	:	1740021930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA CALHOUN OD

Provider Business Mailing Address
First Line	:	105 W I65 SERVICE RD N
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-1202
Country	:	US
Telephone Number	:	251-344-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	10184 EASTERN SHORE BLVD
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5814
Country	:	US
Telephone Number	:	251-301-5650
Fax Number	:	251-581-9011

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	05/29/2025

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