Provider Demographics
NPI:1740341445
Name:PICKRELL, DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PICKRELL
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:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-0203
Mailing Address - Country:US
Mailing Address - Phone:205-913-8747
Mailing Address - Fax:
Practice Address - Street 1:300 EAST ST N
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2085
Practice Address - Country:US
Practice Address - Phone:205-913-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS714-TA328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-58237OtherBC-BS OF ALABAMA
AL113959OtherEYEMED
AL009949205Medicaid
AL000058237Medicaid
AL515-16691OtherBC-BS OF ALABAMA
AL051516691Medicare ID - Type Unspecified
ALU02034Medicare UPIN
AL009949205Medicaid