Healthcare Provider Details

I. General information

NPI: 1750350070
Provider Name (Legal Business Name): BETHANY G HARRINGTON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 S MAIN ST
POPLARVILLE MS
39470-4287
US

IV. Provider business mailing address

PO BOX 521
POPLARVILLE MS
39470-0521
US

V. Phone/Fax

Practice location:
  • Phone: 601-795-0137
  • Fax: 601-795-0148
Mailing address:
  • Phone: 601-795-0137
  • Fax: 601-795-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number685
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: