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General NPI Number Information
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NPI Number | 1134522576
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Entity Type | Organization
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Legal Business Name | IRVING EYE CARE LLC
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 1200 E COUNTY LINE RD STE 166
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City | RIDGELAND
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State | MS
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Zip | 39157-1949
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Country | US
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Telephone | 601-957-6078
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Fax | 601-957-6924
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Provider Business Mailing Address
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Address Line | 1200 E COUNTY LINE RD STE 166
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City | RIDGELAND
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State | MS
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Zip | 39157-1949
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Country | US
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Telephone | 601-957-6078
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Fax | 601-957-6924
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | DR. QUATRISA IRVING
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Credential | O.D.
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Telephone | 601-957-6078
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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 | 836
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License Number State | MS
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