Healthcare Provider Details

I. General information

NPI: 1356987374
Provider Name (Legal Business Name): SAWYER SCOTT EYECARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W MAIN ST
SENATOBIA MS
38668-2146
US

IV. Provider business mailing address

PO BOX 664
SENATOBIA MS
38668-0664
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-6446
  • Fax: 662-562-6155
Mailing address:
  • Phone: 662-562-6446
  • Fax: 662-562-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SALLYE S. SCOTT
Title or Position: OWNER
Credential:
Phone: 662-487-1316