1669513354 NPI number — D-FOUR INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669513354 NPI number — D-FOUR INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D-FOUR INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEARLE VISION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669513354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 MCFARLAND BLVD E
Provider Second Line Business Mailing Address:
121 UNIVERSITY MALL
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35404-5824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-556-2490
Provider Business Mailing Address Fax Number:
205-556-8299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 MCFARLAND BLVD E
Provider Second Line Business Practice Location Address:
121 UNIVERSITY MALL
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35404-5824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-556-2490
Provider Business Practice Location Address Fax Number:
205-556-8299
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEFORD
Authorized Official First Name:
WILMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-556-2490

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 510-59763 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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