Healthcare Provider Details

I. General information

NPI: 1124060744
Provider Name (Legal Business Name): RANKIN EYE PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 SGT PRENTISS DR
NATCHEZ MS
39120-4224
US

IV. Provider business mailing address

120 HOLT COLLIER DR SUITE A
VICKSBURG MS
39183-4408
US

V. Phone/Fax

Practice location:
  • Phone: 601-455-1155
  • Fax: 800-948-4615
Mailing address:
  • Phone: 601-455-1155
  • Fax: 800-948-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number725
License Number StateMS

VIII. Authorized Official

Name: DR. KEMILY ALEXANDER RANKIN
Title or Position: OWNER
Credential: O.D.
Phone: 601-455-1155