Healthcare Provider Details

I. General information

NPI: 1801065636
Provider Name (Legal Business Name): AMORY EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 EARL FRYE BLVD SUITE B
AMORY MS
38821-5503
US

IV. Provider business mailing address

607 EARL FRYE BLVD SUITE B
AMORY MS
38821-5503
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-9711
  • Fax: 662-256-1047
Mailing address:
  • Phone: 662-256-9711
  • Fax: 662-256-1047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS S POWELL
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 662-256-9711