Provider Demographics
NPI:1114998812
Name:COULTER, MORRI (OD)
Entity Type:Individual
Prefix:MS
First Name:MORRI
Middle Name:
Last Name:COULTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 WHITESBURG DRIVE S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3006
Mailing Address - Country:US
Mailing Address - Phone:256-880-8058
Mailing Address - Fax:256-880-1277
Practice Address - Street 1:8200 WHITESBURG DR S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3006
Practice Address - Country:US
Practice Address - Phone:256-880-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-595-TA-298152W00000X
ALS595TA298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529603830Medicaid
AL510-59931OtherBCBSPROVIDER #
AL529603830Medicaid
AL510-59931OtherBCBSPROVIDER #
AL000059931Medicare ID - Type Unspecified