Provider Demographics
NPI:1699910786
Name:FAMILY OPTOMETRY, P.C.
Entity type:Organization
Organization Name:FAMILY OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BILLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-661-1975
Mailing Address - Street 1:5919 TRUSSVILLE CROSSINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-8635
Mailing Address - Country:US
Mailing Address - Phone:205-661-1975
Mailing Address - Fax:205-661-1977
Practice Address - Street 1:5919 TRUSSVILLE CROSSINGS PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-8635
Practice Address - Country:US
Practice Address - Phone:205-661-1975
Practice Address - Fax:205-661-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS919TA498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU76975Medicare UPIN