Provider Demographics
NPI:1053455212
Name:DENT, COLLEEN STANLEY (OD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:STANLEY
Last Name:DENT
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 1:8858 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8538
Mailing Address - Country:US
Mailing Address - Phone:205-759-5594
Mailing Address - Fax:205-759-5594
Practice Address - Street 1:1401 SKYLAND BLVD E
Practice Address - Street 2:IN SAMS CLUB OPTICAL
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-4229
Practice Address - Country:US
Practice Address - Phone:205-345-3893
Practice Address - Fax:205-345-3896
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS477-TA338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT69080Medicare UPIN
AL510-76387OtherBCBS