| Name: | Dr. Marbourg & Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 18 Mar 1993 (32 years ago) |
| Entity Number: | 000-155-553 |
| Register Number: | 000155553 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 5170 TRACE CROSSING DRBIRMINGHAM, AL 35244 |
| Registered Office Street Address ZIP Code: | 35244 |
| Authorized Capital: | $5,000 |
Activities
GENERAL PRACTICE OF OPTOMETRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942357637 | 2007-01-04 | 2008-05-10 | PO BOX 40, ONEONTA, AL, 351210001, US | 308 6TH ST S, SUITE 105, ONEONTA, AL, 351211846, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 205-625-5520 |
| Fax | 2056255522 |
Authorized person
| Name | DR. ROBIN LIVELY MARBOURG |
| Role | SECRETARY |
| Phone | 2056255520 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S-712-TA-055 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLOCK VISION |
| Number | 104527 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529803890 |
| State | AL |
| Name | Role |
|---|---|
| MARBOURG, ROBIN L | Agent |
| Name | Role |
|---|---|
| MARBOURG, JAMES W DR | Incorporator |
| MARBOURG, ROBIN L DR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
