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General NPI Number Information
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NPI Number | 1184417750
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Entity Type | Organization
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Legal Business Name | BERTUCCI EYE CARE
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 15122 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-3120
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Country | US
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Telephone | 228-832-1242
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Fax | 228-832-1285
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Provider Business Mailing Address
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Address Line | 15122 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-3120
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Country | US
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Telephone | 228-832-1242
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Fax | 228-832-1285
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP L BERTUCCI
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Credential | MD
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Telephone | 228-380-4441
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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