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General NPI Number Information
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NPI Number | 1194190496
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI EYE LLC
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 1309 HIGHWAY 35 S
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City | FOREST
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State | MS
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Zip | 39074-5010
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Country | US
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Telephone | 404-481-7931
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Fax |
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Provider Business Mailing Address
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Address Line | 202 MEMORY LN
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City | MADISON
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State | MS
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Zip | 39110-6890
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Country | US
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Telephone | 404-481-7931
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER COOK
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Credential | OD
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Telephone | 404-481-7931
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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 | MS828
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License Number State | MS
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