Provider Demographics
NPI:1053386052
Name:SPALLA, JR., FRANK J (OD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:SPALLA, JR.
Suffix:
Gender:M
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:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-6102
Mailing Address - Country:US
Mailing Address - Phone:205-661-2080
Mailing Address - Fax:205-661-2085
Practice Address - Street 1:4800 WHITESBURG DR S
Practice Address - Street 2:SUITE 26
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1698
Practice Address - Country:US
Practice Address - Phone:256-213-2020
Practice Address - Fax:256-882-9396
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-401-TA-083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051553267Medicaid
ALS-401-TA-083OtherAL BOARD OF OPTOMETRY
ALS-401-TA-083OtherAL BOARD OF OPTOMETRY
AL0051553267Medicare NSC
ALT69077Medicare UPIN