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General NPI Number Information
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NPI Number | 1013430412
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR EYE CARE, LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 08/28/2017
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Provider Practice Location Address
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Address Line | 244 FEATHER LN
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City | CANTON
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State | MS
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Zip | 39046-9793
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Country | US
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Telephone | 601-540-7978
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 36
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City | MADISON
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State | MS
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Zip | 39130-0036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARRYL FRANKLIN
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Credential | OD
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Telephone | 601-540-7978
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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 | 919
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License Number State | MS
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