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General NPI Number Information
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NPI Number | 1245423995
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Entity Type | Organization
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Legal Business Name | MARGO D RAY INC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 7950 CRAFT GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6608
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Country | US
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Telephone | 662-893-3950
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Fax | 662-893-3950
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Provider Business Mailing Address
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Address Line | 7950 CRAFT GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6608
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Country | US
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Telephone | 662-893-3950
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Fax | 662-893-3950
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARGO DENICE BOLER
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Credential | O.D.
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Telephone | 662-893-3950
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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 | 665
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License Number State | MS
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