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General NPI Number Information
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NPI Number | 1164457941
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Entity Type | Individual
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Provider Name | DELLIA SALONE EVANS O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 1461 CANTON MART RD STE A
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City | JACKSON
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State | MS
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Zip | 39211-5413
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Country | US
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Telephone | 601-977-0835
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Fax | 601-977-0689
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Provider Business Mailing Address
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Address Line | 1461 CANTON MART RD STE A
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City | JACKSON
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State | MS
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Zip | 39211-5413
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Country | US
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Telephone | 601-977-0835
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Fax | 601-977-0689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 677
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License Number State | MS
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