Provider Demographics
NPI:1851336226
Name:RETINA SPECIALISTS OF ALABAMA IN MONTGOMERY LLC
Entity Type:Organization
Organization Name:RETINA SPECIALISTS OF ALABAMA IN MONTGOMERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSCIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-263-0105
Mailing Address - Street 1:1201 11TH AVENUE SOUTH
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-933-2625
Mailing Address - Fax:205-558-2553
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:SUITE 314
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-263-0105
Practice Address - Fax:334-264-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1851336226Medicaid
AL1851336226Medicaid