Provider Demographics
NPI:1538204607
Name:DAY OPTOMETRY CLINIC PC
Entity type:Organization
Organization Name:DAY OPTOMETRY CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-631-5681
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-0947
Mailing Address - Country:US
Mailing Address - Phone:205-631-5681
Mailing Address - Fax:205-631-2479
Practice Address - Street 1:137 W SHUGART RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-0947
Practice Address - Country:US
Practice Address - Phone:205-631-5681
Practice Address - Fax:205-631-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS657152W00000X
ALS658152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528502260Medicaid
ALD516Medicare PIN
AL528502260Medicaid
AL0386340001Medicare NSC