Healthcare Provider Details

I. General information

NPI: 1417570029
Provider Name (Legal Business Name): VRF EYE SPECIALTY GROUP, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 DELTA VIEW RD
WALLS MS
38680-8341
US

IV. Provider business mailing address

PO BOX 22510
JACKSON MS
39225-2510
US

V. Phone/Fax

Practice location:
  • Phone: 662-363-3888
  • Fax:
Mailing address:
  • Phone: 901-685-2200
  • Fax: 901-255-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS BROWN
Title or Position: CEO
Credential:
Phone: 901-685-2200