Provider Demographics
NPI:1053167239
Name:POPE, JODIE FARNETTI (OD)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:FARNETTI
Last Name:POPE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 PIERSON AVE # 2332
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2919
Mailing Address - Country:US
Mailing Address - Phone:205-926-4816
Mailing Address - Fax:
Practice Address - Street 1:223 PIERSON AVE # 2332
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042-2919
Practice Address - Country:US
Practice Address - Phone:205-926-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALS-F34-TA-D28152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program