Healthcare Provider Details

I. General information

NPI: 1174635700
Provider Name (Legal Business Name): BATESVILLE VISION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 HIGHWAY 51 N
BATESVILLE MS
38606-2311
US

IV. Provider business mailing address

365 HIGHWAY 51 N
BATESVILLE MS
38606-2311
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-9880
  • Fax: 662-563-9882
Mailing address:
  • Phone: 662-563-9880
  • Fax: 662-563-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number535
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number736
License Number StateMS

VIII. Authorized Official

Name: DR. GLEN H. STONE
Title or Position: OWNER/ DOCTOR
Credential: O.D.
Phone: 662-563-9880