Healthcare Provider Details

I. General information

NPI: 1255471439
Provider Name (Legal Business Name): MS EYE CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DECATUR ST
NEWTON MS
39345-2309
US

IV. Provider business mailing address

PO BOX 628
PHILADELPHIA MS
39350
US

V. Phone/Fax

Practice location:
  • Phone: 601-683-3241
  • Fax: 601-683-3233
Mailing address:
  • Phone: 662-446-9000
  • Fax: 662-779-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number560
License Number StateMS

VIII. Authorized Official

Name: JACOB A IVEY
Title or Position: OD/OWNER
Credential: OD
Phone: 601-683-3241