Provider Demographics
NPI:1265461305
Name:MAMTA D SOMAIYA MD PC
Entity Type:Organization
Organization Name:MAMTA D SOMAIYA MD PC
Other - Org Name:VISIONAMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAMTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOMAIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-943-4650
Mailing Address - Street 1:250 STATE FARM PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7181
Mailing Address - Country:US
Mailing Address - Phone:205-943-4600
Mailing Address - Fax:205-943-4688
Practice Address - Street 1:250 STATE FARM PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7181
Practice Address - Country:US
Practice Address - Phone:205-943-4600
Practice Address - Fax:205-943-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1265461305Medicaid
ALDE5876OtherRR MEDICARE PGBA
AL529928470Medicaid
AL529928470Medicaid
AL1265461305Medicare PIN