Healthcare Provider Details

I. General information

NPI: 1376939975
Provider Name (Legal Business Name): OXFORD UNIVERSITY EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 W OXFORD LOOP 110
OXFORD MS
38655-5714
US

IV. Provider business mailing address

2708 W OXFORD LOOP STE 110
OXFORD MS
38655-5724
US

V. Phone/Fax

Practice location:
  • Phone: 662-213-3937
  • Fax:
Mailing address:
  • Phone: 662-380-5041
  • Fax: 662-380-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number687
License Number StateMS

VIII. Authorized Official

Name: ERIC D RANDLE
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 662-213-3937