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General NPI Number Information
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NPI Number | 1194014118
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Entity Type | Organization
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Legal Business Name | ODOMS EYE CARE, PLLC
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 11/23/2022
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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 | OWNER
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Name | MRS. DELLIA S MCKINNEY
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Credential | OD
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Telephone | 601-977-0835
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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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