Healthcare Provider Details

I. General information

NPI: 1720249279
Provider Name (Legal Business Name): MAX M EDRINGTON OPTOMETRIST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E RAILROAD ST
LONG BEACH MS
39560-4627
US

IV. Provider business mailing address

PO BOX 979
LONG BEACH MS
39560-0979
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 Number
License Number State

VIII. Authorized Official

Name: MAX M EDRINGTON
Title or Position: OWNER
Credential:
Phone: 228-868-2020