Provider Demographics
NPI:1750449542
Name:SAMUEL D. PIERCE, O.D., P.C.
Entity Type:Organization
Organization Name:SAMUEL D. PIERCE, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-655-4838
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173
Mailing Address - Country:US
Mailing Address - Phone:205-655-4838
Mailing Address - Fax:205-655-6996
Practice Address - Street 1:133 N. CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173
Practice Address - Country:US
Practice Address - Phone:205-655-4838
Practice Address - Fax:205-655-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS650TA117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0518840001Medicare NSC