Active NPI
Michelle Ebrahim, OD
- Optometrist
- Dothan, AL
National Provider Identifier
1376645226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- R-129 TA-427
- Practice address
- 3300 S Oates St
Precision Vision, PC
Dothan, AL 36301-5694 - Phone
- (334) 702-0508
- NPI assigned
- Sep 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | R-129 TA-427 | AL | Primary |
Addresses
Primary practice location
3300 S Oates St
Precision Vision, PC
Dothan, AL 36301-5694
Mailing address
1880 Hartford Hwy Apt E23
Dothan, AL 36301-4938
Phone (334) 712-4551
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51096728 | Other | AL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2650 | OK | MD | Professional Counselor |
| R-129 TA-427 | AL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376645226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1880 HARTFORD HWY APT E23",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363014938",
"telephone_number": "334-712-4551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 S OATES ST",
"address_2": "PRECISION VISION, PC",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363015694",
"telephone_number": "334-702-0508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBRAHIM",
"first_name": "MICHELLE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AL",
"license": "R-129 TA-427",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "51096728",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
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- Dynamic Pain & Wellness LLC
- Earl C. Jones, Inc (Dothan Houston County Drug Treatment, Inc.)
- Joseph Easley, MS
- Jennifer Marie Echols, P.A.
- Treva T Eddleman, RDN
- Edge Pine Inc
- Brittney H Edge, CRNP
- Edgewater Pain and Wellness LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.