Provider Demographics
NPI:1043688070
Name:ALABAMA SIGHT CONSERVATION ASSOCIATION
Entity Type:Organization
Organization Name:ALABAMA SIGHT CONSERVATION ASSOCIATION
Other - Org Name:ALABAMA LIONS SIGHT CONVERVATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DURDEN
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-325-8519
Mailing Address - Street 1:700 18TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1856
Mailing Address - Country:US
Mailing Address - Phone:205-325-8519
Mailing Address - Fax:205-933-9215
Practice Address - Street 1:700 18TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1856
Practice Address - Country:US
Practice Address - Phone:205-325-8519
Practice Address - Fax:205-933-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty