Healthcare Provider Details

I. General information

NPI: 1730637521
Provider Name (Legal Business Name): MISSISSIPPI EYECARE ASSOCIATES OF JACKSON, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WEST WOODROW WILSON AVENUE SUITE 300
JACKSON MS
39213
US

IV. Provider business mailing address

310 WEST WOODROW WILSON AVENUE SUITE 300
JACKSON MS
39213
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-9020
  • Fax: 601-321-3979
Mailing address:
  • Phone: 601-366-9020
  • Fax: 601-321-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number941
License Number StateMS

VIII. Authorized Official

Name: JOSHUA HUNTER WILSON
Title or Position: PROVIDER
Credential: O.D.
Phone: 601-366-9020