Provider Demographics
NPI:1124140173
Name:OPTOMETRY EXCHANGE OF ALABAMA, INC
Entity type:Organization
Organization Name:OPTOMETRY EXCHANGE OF ALABAMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:251-675-3666
Mailing Address - Street 1:201 SUMMERVILLE CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3347
Mailing Address - Country:US
Mailing Address - Phone:251-675-3666
Mailing Address - Fax:
Practice Address - Street 1:1088 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3720
Practice Address - Country:US
Practice Address - Phone:251-675-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS428TA270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51523097OtherBLUE CROSS
ALT69186Medicare UPIN