Organization
WYATT- KIRKPATRICK EYE MD ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE MIMS (OFFICE MANAGER)
(334) 874-3403
Entity
Organization
Contact information
Practice address
2 OFFICE PARK CIR, SELMA, AL 36701-6538
(334) 872-3403
(334) 872-3405
Mailing address
2 OFFICE PARK CIR, SELMA, AL 36701-6538
(334) 872-3403
(334) 872-3405
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
S-B10-TA-704
AL
207W00000X
Ophthalmology Physician
Primary
20641
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000002044
—
AL
05
—
009937627
—
AL
05
—
009976795
—
AL
01
—
051002044
BCBS
AL
01
—
051525773
BCBS
AL
01
—
051535830
DR. MUTAI BCBS
AL
01
—
118255
EYEMED
—
01
—
180035890
RAILROAD MEDICARE
—
01
—
G68704
UPIN
—
01
—
P00437321
RAILROAD MEDICARE
—
01
—
V06937
UPIN
—
Enumeration date
01/29/2007
Last updated
04/22/2008
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