Healthcare Provider Details

I. General information

NPI: 1316866262
Provider Name (Legal Business Name): LOUIS MAGEE III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 GOODMAN RD E
SOUTHAVEN MS
38671-9540
US

IV. Provider business mailing address

1228 GOODMAN RD E
SOUTHAVEN MS
38671-9540
US

V. Phone/Fax

Practice location:
  • Phone: 662-893-3300
  • Fax: 662-893-3301
Mailing address:
  • Phone: 662-893-3300
  • Fax: 662-893-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1136
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: