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General NPI Number Information
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NPI Number | 1215014022
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Entity Type | Organization
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Legal Business Name | HATTIESBURG EYE CLINIC CATARACT & LASIK SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 103 MILLSAPS DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1348
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Country | US
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Telephone | 601-268-9959
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Fax |
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Provider Business Mailing Address
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Address Line | 103 MILLSAPS DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1348
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Country | US
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Telephone | 601-268-9959
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Fax | 601-268-9947
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. EDDIE SMITH
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Credential |
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Telephone | 601-268-5910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State | MS
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