Healthcare Provider Details

I. General information

NPI: 1063851822
Provider Name (Legal Business Name): TITUS SNELL ABOC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BEVERLY DR
CLINTON MS
39056-3509
US

IV. Provider business mailing address

PO BOX 923
CLINTON MS
39060-0923
US

V. Phone/Fax

Practice location:
  • Phone: 601-260-1292
  • Fax: 601-510-9191
Mailing address:
  • Phone: 601-260-1292
  • Fax: 601-510-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: