Individual
ELISE DEBRULER AGOSTINELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1720 UNIVERSITY BLVD, BIRMINGHAM, AL 35233-1816
(205) 488-0736
Mailing address
1720 UNIVERSITY BLVD, BIRMINGHAM, AL 35233-1816
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-E53-TA-B84
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S-E53-TA-B84
—
AL
Enumeration date
08/10/2020
Last updated
06/28/2021
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