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General NPI Number Information
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NPI Number | 1194731570
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Entity Type | Organization
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Legal Business Name | GREEN EYE INSTITUTE PA
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 2901 ARLINGTON LOOP
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City | HATTIESBURG
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State | MS
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Zip | 39401-7101
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Country | US
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Telephone | 601-268-5144
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Fax | 601-268-5149
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Provider Business Mailing Address
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Address Line | 2901 ARLINGTON LOOP
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City | HATTIESBURG
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State | MS
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Zip | 39401-7101
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Country | US
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Telephone | 601-268-5144
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Fax | 601-268-5149
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. KIPER NELSON
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Credential | MD
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Telephone | 601-268-5144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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