Provider Demographics
NPI:1073542965
Name:HOOVER VISION CENTER, P.C.
Entity Type:Organization
Organization Name:HOOVER VISION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARBOURG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-985-7640
Mailing Address - Street 1:2801 JOHN HAWKINS PKWY
Mailing Address - Street 2:SUITE 149 M
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4007
Mailing Address - Country:US
Mailing Address - Phone:205-985-7640
Mailing Address - Fax:205-985-7638
Practice Address - Street 1:2801 JOHN HAWKINS PKWY
Practice Address - Street 2:SUITE 149 M
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4007
Practice Address - Country:US
Practice Address - Phone:205-985-7640
Practice Address - Fax:205-985-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529928980Medicaid
AL109180OtherBLOCK VISION
AL109180OtherBLOCK VISION
AL5861130001Medicare NSC