Individual
DR. BRIAN W. MAHALAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
461 COTTON GIN RD, MONTGOMERY, AL 36117-3558
(334) 323-3610
(334) 323-3629
Mailing address
250 STATE FARM PKWY, BIRMINGHAM, AL 35209-7181
(205) 943-4600
(205) 943-4688
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-B98-TA-783
AL
152W00000X
Optometrist
T-194-TA-783
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619923745
—
AL
01
—
515-99302
BC
AL
Enumeration date
06/19/2008
Last updated
09/14/2009
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