Provider Demographics
NPI:1346211281
Name:PEASLEE, ALAN G (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:G
Last Name:PEASLEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 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:205-943-4650
Mailing Address - Fax:205-943-4688
Practice Address - Street 1:1150 EAGLETREE LANE SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-8801
Practice Address - Fax:256-533-8803
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-693-TA-A70152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0753596GMedicaid
GA1122940004Medicare PIN
GA0753596GMedicaid