Provider Demographics
NPI:1639289663
Name:OLTMANNS, VERONICA (OD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:OLTMANNS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 11TH AVE S
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3410
Mailing Address - Country:US
Mailing Address - Phone:205-930-0930
Mailing Address - Fax:205-930-9050
Practice Address - Street 1:1201 11TH AVE S
Practice Address - Street 2:SUITE 501
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3410
Practice Address - Country:US
Practice Address - Phone:205-930-0930
Practice Address - Fax:205-930-9050
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800197152W00000X
ALR-191-TA-865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009237496Medicaid
ALR-191-TA-865OtherALABAMA STATE LICENSE
ALR-191-TA-865OtherALABAMA STATE LICENSE
VA009237496Medicaid