Healthcare Provider Details

I. General information

NPI: 1356904445
Provider Name (Legal Business Name): SAWYER SCOTT EYECARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S MAIN ST
SARDIS MS
38666-1722
US

IV. Provider business mailing address

PO BOX 385
SARDIS MS
38666-0385
US

V. Phone/Fax

Practice location:
  • Phone: 662-487-1316
  • Fax: 662-487-9270
Mailing address:
  • Phone: 662-487-1316
  • Fax: 662-487-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL SAWYER SCOTT
Title or Position: OWNER
Credential: OD
Phone: 662-487-1316