Healthcare Provider Details

I. General information

NPI: 1215089776
Provider Name (Legal Business Name): JACKSON EYE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BAPTIST DR STE 408
MADISON MS
39110-2013
US

IV. Provider business mailing address

1190 N STATE ST SUITE 101
JACKSON MS
39202-2413
US

V. Phone/Fax

Practice location:
  • Phone: 601-853-2020
  • Fax: 601-853-2728
Mailing address:
  • Phone: 601-352-0025
  • Fax: 601-352-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4164
License Number StateMS

VIII. Authorized Official

Name: DR. JOHN H MCVEY
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 601-352-0025