Basic Information
| Provider Information | |||||||||
| NPI: | 1588058317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISION ALABAMA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8567 | ||||||||
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| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359028567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565478634 | ||||||||
| FaxNumber: | 2565473039 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 LEGACY PARK WAY | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565478634 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | CATANZARO | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2565478634 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S-B54-TA-775 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.