Healthcare Provider Details

I. General information

NPI: 1427433200
Provider Name (Legal Business Name): MISSISSIPPI EYECARE ASSOCIATES OF BYRAM, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7118B S SIWELL RD
BYRAM MS
39272-8744
US

IV. Provider business mailing address

404 RIVERWIND DR STE. B-1
PEARL MS
39208-5900
US

V. Phone/Fax

Practice location:
  • Phone: 601-398-3000
  • Fax: 601-398-3002
Mailing address:
  • Phone: 601-398-3000
  • Fax: 601-398-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number783
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number783
License Number StateMS

VIII. Authorized Official

Name: CHRISTOPHER TERRELL BULLIN
Title or Position: OWNER/ PROVIDER
Credential: O.D.
Phone: 601-366-9020