Provider Demographics
NPI:1265485999
Name:UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION
Entity type:Organization
Organization Name:UNIVERSITY OF ALABAMA OPHTHALMOLOGY SERVICES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RETT
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-325-8116
Mailing Address - Street 1:PO BOX 830941
Mailing Address - Street 2:MSC #559
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0941
Mailing Address - Country:US
Mailing Address - Phone:205-325-8620
Mailing Address - Fax:205-325-8333
Practice Address - Street 1:700 18TH STREET SOUTH
Practice Address - Street 2:SUITE 601
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-325-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529901300Medicaid
AL529901300Medicaid