Provider Demographics
NPI:1386849669
Name:BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES
Entity Type:Organization
Organization Name:BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES
Other - Org Name:BROOKWOOD OPHTHALMOLOGY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:NORFLEET
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-383-9498
Mailing Address - Street 1:1 CHASE CORPORATE DR STE 439
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1026
Mailing Address - Country:US
Mailing Address - Phone:205-313-6300
Mailing Address - Fax:253-645-4859
Practice Address - Street 1:1 CHASE CORPORATE DR STE 439
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1026
Practice Address - Country:US
Practice Address - Phone:205-313-6300
Practice Address - Fax:253-465-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533857OtherBCBS MARION
AL051533202Medicaid
AL51533202OtherBCBS AL BROOKWOOD
ALP00301433OtherMEDICARE RAILROAD
AL4648847OtherAETNA
ALA96597OtherVIVA
AL009936633Medicaid
AL213985282OtherTRICARE STANDARD HUMANA
AL4648847OtherAETNA
ALP00301433OtherMEDICARE RAILROAD
AL=========OtherUMWA
ALA96597OtherVIVA
AL=========OtherGEHA PPO USA
AL=========OtherCHAMPUS
AL213985282OtherTRICARE STANDARD HUMANA
AL051533202Medicaid
AL=========OtherCHAMPUS