Healthcare Provider Details

I. General information

NPI: 1336172428
Provider Name (Legal Business Name): MAX M EDRINGTON OPTOMETRIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E RAILROAD ST
LONG BEACH MS
39560
US

IV. Provider business mailing address

PO BOX 979
LONG BEACH MS
39560
US

V. Phone/Fax

Practice location:
  • Phone: 228-868-2020
  • Fax: 228-863-2695
Mailing address:
  • Phone: 228-868-2020
  • Fax: 228-863-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number431
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: