Individual
BETHANY SURREY MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-1900
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-A98-TA-671
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1586102
EMERGENCY LA MEDICAID
AL
01
—
51529006
BCBS
AL
01
—
7533266
MISSISSIPPI MEDICAID
AL
01
—
V05450
VIVA
AL
Enumeration date
05/16/2006
Last updated
07/09/2007
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