Healthcare Provider Details

I. General information

NPI: 1033917638
Provider Name (Legal Business Name): HOLLY SPRINGS EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W COMMERCE ST
HERNANDO MS
38632-2240
US

IV. Provider business mailing address

302 RAILROAD ST
WATER VALLEY MS
38965-3032
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-1818
  • Fax: 662-562-0600
Mailing address:
  • Phone: 662-473-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHEN PATRICK EDWARDS
Title or Position: OWNER
Credential: OD
Phone: 662-473-2181