Provider Demographics
NPI:1851496087
Name:TUSCALOOSA OPHTHALMOLOGY, P.C.
Entity Type:Organization
Organization Name:TUSCALOOSA OPHTHALMOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-556-2121
Mailing Address - Street 1:535 JACK WARNER PKWY NE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5751
Mailing Address - Country:US
Mailing Address - Phone:205-556-2121
Mailing Address - Fax:205-554-0152
Practice Address - Street 1:535 JACK WARNER PKWY NE
Practice Address - Street 2:SUITE B-1
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5751
Practice Address - Country:US
Practice Address - Phone:205-556-2121
Practice Address - Fax:205-554-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty