1891103875 NPI number — MS. MALLORY ELIZABETH MCGUIRE OD

Table of content: MS. MALLORY ELIZABETH MCGUIRE OD (NPI 1891103875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891103875 NPI number — MS. MALLORY ELIZABETH MCGUIRE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGUIRE
Provider First Name:
MALLORY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1891103875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1310
Provider Second Line Business Mailing Address:
SCHAEFFER EYE CENTER
Provider Business Mailing Address City Name:
TRUSSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35173-1376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-661-2080
Provider Business Mailing Address Fax Number:
205-661-2085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1686 MONTGOMERY HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-979-2020
Provider Business Practice Location Address Fax Number:
205-978-6487
Provider Enumeration Date:
07/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  SD24 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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