Healthcare Provider Details

I. General information

NPI: 1528360377
Provider Name (Legal Business Name): TAYLOR EYECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 HIGHWAY 18 SUITE D
BRANDON MS
39042-2773
US

IV. Provider business mailing address

2155 HIGHWAY 18 SUITE D
BRANDON MS
39042-2773
US

V. Phone/Fax

Practice location:
  • Phone: 601-951-0472
  • Fax: 502-499-2198
Mailing address:
  • Phone: 601-951-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMS747
License Number StateMS

VIII. Authorized Official

Name: ANNA P TAYLOR
Title or Position: OWNER
Credential: O.D.
Phone: 601-951-0472