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General NPI Number Information
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NPI Number | 1235553322
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI VISION CENTER
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 2711 GREENWAY DR STE A
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City | JACKSON
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State | MS
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Zip | 39204-3304
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Country | US
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Telephone | 601-922-9300
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Fax | 601-922-6312
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Provider Business Mailing Address
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Address Line | 2711 GREENWAY DR STE A
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City | JACKSON
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State | MS
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Zip | 39204-3304
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Country | US
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Telephone | 601-922-9300
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Fax | 601-922-6312
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Authorized Official
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Title or Position | MANAGER
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Name | SHANNA L JENKINS
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Credential |
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Telephone | 601-853-1998
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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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