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General NPI Number Information
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NPI Number | 1003851304
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Entity Type | Organization
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Legal Business Name | ABERDEEN EYE CLINIC P A
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 114 N HICKORY ST
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City | ABERDEEN
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State | MS
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Zip | 39730-2648
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Country | US
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Telephone | 662-369-2444
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Fax | 662-369-7223
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Provider Business Mailing Address
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Address Line | PO BOX 955
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City | ABERDEEN
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State | MS
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Zip | 39730-0955
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Country | US
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Telephone | 662-369-2444
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Fax | 662-369-7223
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY CONSTANCE LONG
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Credential | O.D.
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Telephone | 662-369-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 490
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License Number State | MS
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