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General NPI Number Information
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NPI Number | 1275495673
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Entity Type | Organization
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Legal Business Name | GATES EYE CARE LLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 100 MCCORD RD
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City | PONTOTOC
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State | MS
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Zip | 38863-6245
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Country | US
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Telephone | 662-322-6009
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Fax | 662-553-5480
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Provider Business Mailing Address
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Address Line | 100 MCCORD RD
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City | PONTOTOC
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State | MS
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Zip | 38863-6245
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Country | US
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Telephone | 662-322-6009
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Fax | 662-553-5480
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Authorized Official
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Title or Position | OWNER
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Name | MCKENZIE LEE GATES
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Credential | O.D.
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Telephone | 662-322-6009
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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 |
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License Number State |
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