Provider Demographics
NPI:1679028369
Name:ALABAMA FAMILY OPTOMETRY
Entity Type:Organization
Organization Name:ALABAMA FAMILY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:DANIELE
Authorized Official - Last Name:VALENTINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-403-5170
Mailing Address - Street 1:60 COMMONS WAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-3465
Mailing Address - Country:US
Mailing Address - Phone:256-403-5170
Mailing Address - Fax:
Practice Address - Street 1:60 COMMONS WAY
Practice Address - Street 2:SUITE E
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-3465
Practice Address - Country:US
Practice Address - Phone:256-403-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-172-TA-809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU82210Medicare UPIN