Healthcare Provider Details

I. General information

NPI: 1700859881
Provider Name (Legal Business Name): TRI COUNTY EYE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 05/25/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 BERTUCCI BLVD
BILOXI MS
39531-2255
US

IV. Provider business mailing address

431 BERTUCCI BLVD
BILOXI MS
39531-2255
US

V. Phone/Fax

Practice location:
  • Phone: 228-385-2020
  • Fax: 228-388-9435
Mailing address:
  • Phone: 228-385-2020
  • Fax: 228-388-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY EMILE BERTUCCI
Title or Position: OPHTHALMOLOGIST/OWNER
Credential: M.D.
Phone: 228-385-2020