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General NPI Number Information
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NPI Number | 1306869235
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Entity Type | Organization
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Legal Business Name | CROSSROAD EYE CENTER LLC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 3035 CORDER DR
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City | CORINTH
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State | MS
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Zip | 38834-6216
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Country | US
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Telephone | 662-286-9292
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Fax | 662-286-9293
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Provider Business Mailing Address
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Address Line | 3035 CORDER DR PO BOX 1740
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City | CORINTH
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State | MS
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Zip | 38834-6216
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Country | US
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Telephone | 662-286-9292
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Fax | 662-286-9293
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DARWIN B WOOTEN
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Credential | M.D.
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Telephone | 662-286-9292
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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 | 16628
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License Number State | MS
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