Provider Demographics
NPI:1518264258
Name:COMPREHENSIVE MEDICAL EYE OPHTHALMIC CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL EYE OPHTHALMIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ SOLE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BAREFIELD-PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-999-2635
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-1146
Mailing Address - Country:US
Mailing Address - Phone:205-999-2635
Mailing Address - Fax:205-252-7292
Practice Address - Street 1:401 TUSCALOOSA AVE SW
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1416
Practice Address - Country:US
Practice Address - Phone:205-999-2635
Practice Address - Fax:205-252-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4482207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1811972813OtherINDIVIDUAL NPI