Provider Demographics
NPI:1497052591
Name:MICHAEL GRIFFIN PC
Entity Type:Organization
Organization Name:MICHAEL GRIFFIN PC
Other - Org Name:DOTHAN OPTOMETRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-479-0043
Mailing Address - Street 1:206 MEDICAL CARE WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4765
Mailing Address - Country:US
Mailing Address - Phone:334-794-8797
Mailing Address - Fax:334-479-0658
Practice Address - Street 1:1450 ROSS CLARK CIR
Practice Address - Street 2:SUITE 400
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4765
Practice Address - Country:US
Practice Address - Phone:334-479-0043
Practice Address - Fax:334-792-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS774-TA-431152W00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127693Medicaid