MEDICARE: EYES2SEE, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	661	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639611619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES2SEE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 510
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-0510
Country	:	US
Telephone Number	:	662-534-9288
Fax Number	:	662-534-8341

Provider Business Practice Location Address
First Line	:	109 STATE HIGHWAY 15 S
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-5206
Country	:	US
Telephone Number	:	662-534-9288
Fax Number	:	662-534-8341

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	DR. JULIE C. BROCK
Credential	:	O.D.
Telephone Number	:	662-316-3761

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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Directions to “EYES2SEE, P.A. ” Practice Location

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