Healthcare Provider Details

I. General information

NPI: 1932021078
Provider Name (Legal Business Name): FLORAL OPTIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COUNTRY CLUB DR
GREENWOOD MS
38930-6802
US

IV. Provider business mailing address

8850 MIDSOUTH DR PO BOX 571
OLIVE BRANCH MS
38654-9998
US

V. Phone/Fax

Practice location:
  • Phone: 662-897-6831
  • Fax:
Mailing address:
  • Phone: 662-897-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AZALIA ROCHELLE ROACH
Title or Position: OPTOMETRIST
Credential: OD
Phone: 662-897-6831