Provider Demographics
NPI:1093700569
Name:VICK, VALERIE LANETTE (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LANETTE
Last Name:VICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2457
Mailing Address - Country:US
Mailing Address - Phone:251-473-1900
Mailing Address - Fax:251-470-8943
Practice Address - Street 1:2880 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2457
Practice Address - Country:US
Practice Address - Phone:251-473-1900
Practice Address - Fax:251-470-8943
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026191207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06933501Medicaid
AL51530974OtherBLUE CROSS AL PROVIDER #
AL7774388OtherAETNA PROVIDER #
AL51536741OtherBLUE CROSS AL PROVIDER #
ALH60653OtherHEALTHSPRING PROVIDER #
AL0810507OtherUNITED HEALTHCARE PROV. #
AL51000539OtherBLUE CROSS AL PROVIDER #
AL51536741OtherBLUE CROSS AL PROVIDER #
ALP00153181Medicare PIN