Provider Demographics
NPI:1538052170
Name:MORTON, MALLORY ALDRIDGE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ALDRIDGE
Last Name:MORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-6725
Mailing Address - Country:US
Mailing Address - Phone:205-442-3267
Mailing Address - Fax:
Practice Address - Street 1:1320 MCFARLAND BLVD E STE 560
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5899
Practice Address - Country:US
Practice Address - Phone:205-710-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-F54152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist