Healthcare Provider Details

I. General information

NPI: 1417868928
Provider Name (Legal Business Name): CROSSROADS VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15218 CROSSROADS PKWY STE B
GULFPORT MS
39503-3564
US

IV. Provider business mailing address

15218 CROSSROADS PKWY STE B
GULFPORT MS
39503-3564
US

V. Phone/Fax

Practice location:
  • Phone: 228-831-5595
  • Fax: 228-831-5540
Mailing address:
  • Phone:
  • 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. MAX MAURICE EDRINGTON
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 228-861-2714