Provider Demographics
NPI:1679754659
Name:DR. OPTICAL P.C.
Entity Type:Organization
Organization Name:DR. OPTICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:FINGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-854-6700
Mailing Address - Street 1:5239 OLD SPRINGVILLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-7607
Mailing Address - Country:US
Mailing Address - Phone:205-854-6700
Mailing Address - Fax:
Practice Address - Street 1:5239 OLD SPRINGVILLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-7607
Practice Address - Country:US
Practice Address - Phone:205-854-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS630TA251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058157OtherBLUE CROSS
AL924396OtherBLOCK VISION
MD40510OtherSPECTERA
410015946OtherRAILROAD MEDICARE
AL5292024410Medicaid
AL000058157OtherBLUE CROSS
AL000058157OtherBLUE CROSS