Individual
DR. MARK WADE SHIREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7921 TANNER WILLIAMS RD, SUITE H, MOBILE, AL 36608-8312
(251) 634-2144
(251) 634-2145
Mailing address
7921 TANNER WILLIAMS RD, SUITE H, MOBILE, AL 36608-8308
(251) 634-2144
(251) 634-2145
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-968-TA-542
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51514440
BCBS PROVIDER NUMBER
AL
01
—
S-968-TA-542
STATE LICENSE NUMBER
AL
Enumeration date
09/06/2005
Last updated
03/07/2023
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