Provider Demographics
NPI:1740021930
Name:CALHOUN, SAMANTHA (OD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W I65 SERVICE RD N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1202
Mailing Address - Country:US
Mailing Address - Phone:251-344-2020
Mailing Address - Fax:
Practice Address - Street 1:105 W I65 SERVICE RD N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1202
Practice Address - Country:US
Practice Address - Phone:251-344-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-F44-TA-D41152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist