Healthcare Provider Details

I. General information

NPI: 1003952383
Provider Name (Legal Business Name): COLDWATER VISION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CENTRAL AVENUE
COLDWATER MS
38618
US

IV. Provider business mailing address

PO BOX 486
COLDWATER MS
38618-0486
US

V. Phone/Fax

Practice location:
  • Phone: 662-622-5173
  • Fax: 662-622-5590
Mailing address:
  • Phone: 662-622-5173
  • Fax: 662-622-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. KRISTOPHER ALAN MAY
Title or Position: OWNER
Credential: OD
Phone: 662-622-5173