Provider Demographics
NPI:1316088313
Name:MORTON, LAURA NOLES (OD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NOLES
Last Name:MORTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 CHEROKEE AVE SW STE D
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-7503
Mailing Address - Country:US
Mailing Address - Phone:256-775-0499
Mailing Address - Fax:256-775-0434
Practice Address - Street 1:1850 CHEROKEE AVE SW STE D
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-7503
Practice Address - Country:US
Practice Address - Phone:256-775-0499
Practice Address - Fax:256-775-0434
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS858TA412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4044774Medicaid
AL4044774Medicaid
ALU68585Medicare UPIN