Provider Demographics
NPI:1760658835
Name:SHIRLEY, DAVID (OPTICAN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:OPTICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1809
Mailing Address - Country:US
Mailing Address - Phone:205-822-4696
Mailing Address - Fax:
Practice Address - Street 1:625 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1809
Practice Address - Country:US
Practice Address - Phone:205-822-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL156FX1800X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician