Provider Demographics
NPI:1487677811
Name:THE UNIVERSITY OF ALABAMA AT BIRMINGHAM
Entity Type:Organization
Organization Name:THE UNIVERSITY OF ALABAMA AT BIRMINGHAM
Other - Org Name:UAB EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-996-6038
Mailing Address - Street 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-975-2020
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCK0183OtherRAILROAD MEDICARE
AL44262OtherSPECTERA
Q002OtherBLUE CROSS/BLUE SHIELD CO
AL528402230OtherMEDICAID
AL528402230OtherMEDICAID
AL528402230OtherMEDICAID
AL0279620004Medicare NSC