Basic Information
| Provider Information | |||||||||
| NPI: | 1053386052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPALLA, JR. | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1310 | ||||||||
| Address2: | |||||||||
| City: | TRUSSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351736102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056612080 | ||||||||
| FaxNumber: | 2056612085 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 WHITESBURG DR S | ||||||||
| Address2: | SUITE 26 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562132020 | ||||||||
| FaxNumber: | 2568829396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 09/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S-401-TA-083 | AL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 051553267 | 05 | AL | MEDICAID | MS0172902 | 01 | AL | DEA | OTHER | S-401-TA-083 | 01 | AL | AL BOARD OF OPTOMETRY | OTHER |