| Name: | Dr. Brian R. Pettie Eyecare, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 24 Mar 2005 (20 years ago) |
| Entity Number: | 000-240-596 |
| Register Number: | 000240596 |
| ZIP code: | 35206 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 9248 PKWY EBIRMINGHAM, AL 35206 |
| Authorized Capital: | $100 |
Activities
RENDERING PROFESSIONAL OPTOMETRY SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215135967 | 2007-07-04 | 2020-08-22 | 9248 PARKWAY E, BIRMINGHAM, AL, 352061509, US | 9248 PARKWAY E, BIRMINGHAM, AL, 352061509, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-833-3171 |
| Fax | 2058333059 |
Authorized person
| Name | DR. BRIAN ROLAND PETTIE |
| Role | OWNER |
| Phone | 2058333171 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S-A54-TA-634 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS AL IRONDALE LOCATION |
| Number | 51532635 |
| State | AL |
| Issuer | VIVA |
| Number | U99431 |
| State | AL |
| Issuer | BCBS AL ROEBUCK LOCATION |
| Number | 51538863 |
| State | AL |
| Issuer | VIVA MEDICARE PLUS |
| Number | U99431 |
| State | AL |
| Name | Role |
|---|---|
| PETTIE, BRIAN R | Agent |
| Name | Role | Address |
|---|---|---|
| SMITH, ELIZABETH A | Incorporator | 2711 CENTERVILLE ROAD SUITE 400WILMINGTON, DE 19808 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
