Provider Demographics
NPI:1780791376
Name:UNIVERSITY OF ALABAMA AT BIRMINGHAM
Entity type:Organization
Organization Name:UNIVERSITY OF ALABAMA AT BIRMINGHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCIAL AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-934-5493
Mailing Address - Street 1:1701 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294
Mailing Address - Country:US
Mailing Address - Phone:205-934-5161
Mailing Address - Fax:205-975-6534
Practice Address - Street 1:1701 9TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294
Practice Address - Country:US
Practice Address - Phone:205-934-5161
Practice Address - Fax:205-975-6534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ALABAMAAT BIRMINGHAM SCHOOL OF OPTOMETRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5283000160Medicaid
AL5283000160Medicaid
ALDE2352Medicare PIN
ALF892Medicare ID - Type Unspecified
ALCK0017Medicare PIN