MEDICARE: SAMUEL D PIERCE 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	S650-TA-117	AL

General Provider Information

NPI Number	:	1801877311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL D PIERCE O.D.

Provider Business Mailing Address
First Line	:	133 CHALKVILLE RD
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173
Country	:	US
Telephone Number	:	205-655-4838
Fax Number	:	205-655-6996

Provider Business Practice Location Address
First Line	:	133 CHALKVILLE RD
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173
Country	:	US
Telephone Number	:	205-655-4838
Fax Number	:	205-655-6996

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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