Healthcare Provider Details

I. General information

NPI: 1770221301
Provider Name (Legal Business Name): OPHTHALMOLOGY CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BAPTIST DR STE 220
MADISON MS
39110-2031
US

IV. Provider business mailing address

501 BAPTIST DR STE 220
MADISON MS
39110-2031
US

V. Phone/Fax

Practice location:
  • Phone: 601-985-9120
  • Fax: 601-985-9122
Mailing address:
  • Phone: 601-985-9120
  • Fax: 601-985-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE MOORE
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 601-985-9120