Healthcare Provider Details

I. General information

NPI: 1689763682
Provider Name (Legal Business Name): EYEMASTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 METROCENTER SUITE 113
JACKSON MS
39209
US

IV. Provider business mailing address

PO BOX 848448
DALLAS TX
75284-8448
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-8948
  • Fax: 601-355-9879
Mailing address:
  • Phone: 210-524-6663
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DOUG NEWCOM
Title or Position: OFFICER
Credential:
Phone: 210-524-6700