Individual
MICHELLE EBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3300 S OATES ST, PRECISION VISION, PC, DOTHAN, AL 36301-5694
(334) 702-0508
Mailing address
1880 HARTFORD HWY APT E23, DOTHAN, AL 36301-4938
(334) 712-4551
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
R-129 TA-427
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51096728
BLUE CROSS BLUE SHIELD
AL
Enumeration date
09/02/2006
Last updated
07/08/2007
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