Individual
DR. KENT M DAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
251 N BAYOU ST, MOBILE, AL 36603-5827
(251) 690-8894
Mailing address
251 N BAYOU ST, MOBILE, AL 36603-5827
(251) 690-8894
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4903
MA
152W00000X
Optometrist
Primary
S-B49TA-200
AL
152W00000X
Optometrist
T73-TA-200
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059867
—
AL
05
—
00477761
—
MS
01
—
011846
MEDICARE GROUP PAYEE NUMBER
AL
01
—
1063439065
NPI GROUP PAYEE NUMBER
AL
05
—
1586056
—
LA
01
—
410021238
MEDICARE RAILROAD
AL
01
—
51059952
BLUE CROSS BLUE SHIELD
AL
01
—
51527365
BLUE CROSS BLUE SHIELD
AL
05
—
630000013
—
AL
01
—
A1716 636005396
VISION SERVICE PLAN
AL
Enumeration date
07/31/2006
Last updated
05/28/2013
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