Healthcare Provider Details

I. General information

NPI: 1114448800
Provider Name (Legal Business Name): MEGAN SUMRALL, OD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7127 HIGHWAY 98 SUITE 30
HATTIESBURG MS
39402
US

IV. Provider business mailing address

7117 US HWY 98 SUITE 30
HATTIESBURG MS
39402
US

V. Phone/Fax

Practice location:
  • Phone: 601-470-2020
  • Fax: 800-493-5956
Mailing address:
  • Phone: 601-475-2020
  • Fax: 800-493-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number760
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number760
License Number StateMS

VIII. Authorized Official

Name: MEGAN LOTT
Title or Position: MANAGER
Credential: OD
Phone: 601-475-2020