Jeremy Edgerly, OD, LLC
Organization Active NPI Optometrist · Mountain Brook, AL
NPI 1679290332 · NPPES record last updated Oct 24, 2022
Key facts
- NPI
- 1679290332
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- JEREMY EDGERLY, OD, LLC
- Practice address
- 921 Jemison Lane
Mountain Brook, AL 35223 - Phone
- (205) 341-9595
- NPI assigned
- Oct 24, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeremy Daniel Edgerly, OD
- Title
- Sole Member/Optometrist
- Phone
- (205) 341-9595
Practitioners 1
-
Jeremy Daniel Edgerly, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221227001488 | AL | Part B Supplier - Clinic/Group Practice | 7012387509 |
Receives reassigned benefits from 1 practitioner Practice locations: Mountain Brook, AL |
National Provider Directory
Locations
921 Jemison Ln
Mountain Brook, AL 35223
Phone (205) 341-9595
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
921 Jemison Lane
Mountain Brook, AL 35223
Mailing address
3504 Branch Mill Rd
Mountain BRK, AL 35223-1608
Phone (205) 341-9595
Other providers in Mountain Brook, AL
- Jeremy Daniel Edgerly
- Tommy Gene Foster Jr.
- Heidi Bullock Counseling LLC
- HGD, Inc
- J Walden Retan MD PC
- Kimberly Brooke Lankford
- Beth Anne Malizia
- Mara Okshteyn, M.D.
- Mountain Brook City
- Jack Murbach
All providers in Mountain Brook, AL · Optometrist in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.