Healthcare Provider Details

I. General information

NPI: 1427002864
Provider Name (Legal Business Name): THE EYE CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 23RD AVE
GULFPORT MS
39501-2965
US

IV. Provider business mailing address

PO BOX 148
GULFPORT MS
39502-0148
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-2633
  • Fax: 228-865-0339
Mailing address:
  • Phone: 228-864-2633
  • Fax: 228-865-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM C SAMS III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 228-864-2633