Provider Demographics
NPI:1609072545
Name:COLE, DAVID MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:COLE
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 1:14403 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1223
Mailing Address - Country:US
Mailing Address - Phone:256-974-4555
Mailing Address - Fax:
Practice Address - Street 1:14403 COURT ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1223
Practice Address - Country:US
Practice Address - Phone:256-974-4555
Practice Address - Fax:256-736-5543
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B56152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I419534Medicare PIN
ALE869Medicare PIN