Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | S-881-TA-462 | AL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | S-881-TA-462 | AL |
NPI | 1285856542 |
---|---|
Provider Name | Dr. Andrea Beavers Hudson |
First Address | Vestavia, AL 35216-1923 |
Second Address | Birmingham, AL 35233-2927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U71876 | (02) | AL |