Healthcare Provider Details

I. General information

NPI: 1093420671
Provider Name (Legal Business Name): HOLLY SPRINGS EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MAIN ST
SENATOBIA MS
38668-2138
US

IV. Provider business mailing address

106 E MAIN ST
SENATOBIA MS
38668-2138
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-5500
  • Fax:
Mailing address:
  • Phone: 662-562-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHEN PATRICK EDWARDS
Title or Position: OWNER
Credential: OD
Phone: 662-473-2181