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General NPI Number Information
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NPI Number | 1093020893
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Entity Type | Organization
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Legal Business Name | JOSHUA E. BOSTICK, O.D., P.A.
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 122 WILLOWBROOK DR
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City | SALTILLO
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State | MS
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Zip | 38866-6895
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Country | US
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Telephone | 662-869-1779
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Fax | 662-869-3776
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Provider Business Mailing Address
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Address Line | 122 WILLOWBROOK DR
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City | SALTILLO
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State | MS
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Zip | 38866-6895
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Country | US
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Telephone | 662-869-1779
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Fax | 662-869-3776
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOSHUA EDWIN BOSTICK
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Credential | O.D.
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Telephone | 662-869-1779
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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 | 821
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License Number State | MS
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