Healthcare Provider Details

I. General information

NPI: 1043993678
Provider Name (Legal Business Name): MS EYE CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 EASEL ST
TAYLOR MS
38673-1003
US

IV. Provider business mailing address

PO BOX 628
PHILADELPHIA MS
39350-0628
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-9394
  • Fax:
Mailing address:
  • Phone: 662-446-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMMY WOMBLE
Title or Position: CREDENTIALING
Credential:
Phone: 662-773-3494