Healthcare Provider Details

I. General information

NPI: 1164428868
Provider Name (Legal Business Name): JACKSON EYE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST SUITE 330
JACKSON MS
39202-2000
US

IV. Provider business mailing address

P O BOX 23665 STE 403
JACKSON MS
39225-3665
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-2020
  • Fax: 601-352-5988
Mailing address:
  • Phone: 601-353-2020
  • Fax: 601-352-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0506678
License Number StateMS

VIII. Authorized Official

Name: DR. JOHN H MCVEY
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 601-353-2020