Organization
OAK MOUNTAIN EYE CARE PC
Active
Other names
Vision Source Michael D. Blackburn, O.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D BLACKBURN OD (PRESIDENT OWNER)
(205) 980-5152
Entity
Organization
Contact information
Practice address
4960 VALLEYDALE RD, SUITE 201, BIRMINGHAM, AL 35242-4613
(205) 980-5152
(205) 980-5154
Mailing address
4960 VALLEYDALE RD, SUITE 201, BIRMINGHAM, AL 35242-4613
(205) 980-5152
(205) 980-5154
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S672TA330
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51500011
BLUE CROSS BLUE SHIELD
AL
01
—
P00105638
RAILROAD MEDICARE
—
Enumeration date
12/14/2005
Last updated
02/21/2012
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