Basic Information
| Provider Information | |||||||||
| NPI: | 1285644666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | FELTON | ||||||||
| MiddleName: | |||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1716 UNIVERSITY BLVD | ||||||||
| Address2: | HPB G080A | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344748 | ||||||||
| FaxNumber: | 2059346755 | ||||||||
| Practice Location | |||||||||
| Address1: | 1716 UNIVERSITY BLVD | ||||||||
| Address2: | HPB G080A | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059752020 | ||||||||
| FaxNumber: | 2059346755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 06/25/2010 | ||||||||
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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 | S346TA314 | AL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000058736 | 05 | AL | MEDICAID | 051058736 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 3656 | 01 | AL | SENIOR 1ST | OTHER | 4803280001 | 01 | AL | PALMETTO | OTHER | 2210082 | 01 | AL | UNITED HEALTH CARE | OTHER | T69019 | 01 | AL | VIVA | OTHER | 051059706 | 01 | AL | BCBS | OTHER | 051059706 | 01 | AL | VIVA | OTHER | 05226256 | 05 | MS | MEDICAID | 410042855 | 01 | MEDICARE RAILROAD | OTHER | 1586412 | 05 | LA | MEDICAID |