Oak Mountain Eye Care PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

S672TA330 Issued in AL

Legal business name

OAK MOUNTAIN EYE CARE PC

Doing business as

Vision Source Michael D. Blackburn, O.D.

Practice address

4960 Valleydale Rd
Suite 201
Birmingham, AL 35242-4613

Phone

(205) 980-5152

Fax

(205) 980-5154

NPI assigned

Dec 14, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael D Blackburn, ODNPI 1538144399

Title

President Owner

Phone

(205) 980-5152

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Vision Source Michael D. Blackburn, O.D. Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael D Blackburn, OD

  • Optometrist
  • Birmingham, AL
  • NPI 1538144399
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1255316006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4960 VALLEYDALE RD",
            "address_2": "SUITE 201",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352424613",
            "telephone_number": "205-980-5152",
            "fax_number": "205-980-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4960 VALLEYDALE RD",
            "address_2": "SUITE 201",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352424613",
            "telephone_number": "205-980-5152",
            "fax_number": "205-980-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK MOUNTAIN EYE CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "205-980-5152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S672TA330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51500011",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00105638",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source Michael D. Blackburn, O.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hugh Pinkney O'Shields Jr., MD
• Rebecca Hathaway O'Shields, LCSW
• Brenna O'Steen, RBT
• Oak Knoll Health and Rehabilitation, LLC
• Oak Mountain Counseling LLC
• Oak Mountain Group Services, LLC
• Oak Mountain Orthodontics PC
• Oak Street Health Physicians Group of Alabama, LLC
• Allen Si Won Oak, MD
• Hannah Oakes

• Optometrist in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.