Provider Demographics
NPI:1336236579
Name:ALABASTER OPTICAL, INC.
Entity Type:Organization
Organization Name:ALABASTER OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-663-2177
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-2020
Mailing Address - Country:US
Mailing Address - Phone:205-663-2177
Mailing Address - Fax:205-663-4743
Practice Address - Street 1:300 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8764
Practice Address - Country:US
Practice Address - Phone:205-663-2177
Practice Address - Fax:205-663-4743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
AL4081332S00000X
AL2158332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332H00000XSuppliersEyewear Supplier
Not Answered332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935242Medicaid
AL51059465OtherBCBS