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General NPI Number Information
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NPI Number | 1013256411
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI EYECARE ASSOCIATES OF PEARL, PLLC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 404 RIVERWIND DR STE B1
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City | PEARL
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State | MS
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Zip | 39208-5900
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Country | US
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Telephone | 601-366-9020
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Fax | 601-321-3979
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Provider Business Mailing Address
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Address Line | 404 RIVERWIND DR STE B1
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City | PEARL
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State | MS
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Zip | 39208-5900
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Country | US
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Telephone | 601-366-9020
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Fax | 601-321-3979
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. AMANDA GUIDRY
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Credential |
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Telephone | 601-366-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 783
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 783
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License Number State | MS
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