Provider Demographics
NPI:1942313911
Name:AMOS, JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:AMOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:G080A/HPB
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0001
Mailing Address - Country:US
Mailing Address - Phone:205-975-9827
Mailing Address - Fax:205-975-8281
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:G080A/HPB
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-9827
Practice Address - Fax:205-975-8281
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT10TA103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51059352OtherBCBS OF ALABAMA
ALT68310OtherVIVA
AL51059861OtherBCBS
AL51059861OtherBCBS
ALT68310OtherVIVA
AL1387502Medicare ID - Type UnspecifiedUMWA
0279620004Medicare NSC