Provider Demographics
NPI:1801421904
Name:ALABAMA OCULOPLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:ALABAMA OCULOPLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MIRELES
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-265-7863
Mailing Address - Street 1:910 ADAMS ST SE STE 130
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3751
Mailing Address - Country:US
Mailing Address - Phone:256-265-7863
Mailing Address - Fax:
Practice Address - Street 1:910 ADAMS ST SE STE 130
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3751
Practice Address - Country:US
Practice Address - Phone:256-265-6344
Practice Address - Fax:256-265-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty