Provider Demographics
NPI:1184839268
Name:RETINA SPECIALISTS OF NORTH ALABAMA LLC
Entity Type:Organization
Organization Name:RETINA SPECIALISTS OF NORTH ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-740-0601
Mailing Address - Street 1:1201 11TH AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 SOUTH MARENGO ST
Practice Address - Street 2:SUITE K
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6034
Practice Address - Country:US
Practice Address - Phone:256-740-0601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529906990Medicaid
ALI492Medicare PIN