Provider Demographics
NPI:1588712707
Name:BRIAN P INGLE OPTOMETRY, LLC
Entity type:Organization
Organization Name:BRIAN P INGLE OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:INGLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-760-8072
Mailing Address - Street 1:213 COX CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1572
Mailing Address - Country:US
Mailing Address - Phone:256-760-8072
Mailing Address - Fax:256-718-8499
Practice Address - Street 1:213 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1572
Practice Address - Country:US
Practice Address - Phone:256-760-8072
Practice Address - Fax:256-718-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS586TA222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALUO1854Medicare UPIN
AL000032944Medicare ID - Type Unspecified