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General NPI Number Information
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NPI Number | 1316625379
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Entity Type | Individual
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Provider Name | NHA NGO OD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 12199 US-49 N UNIT 100
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City | GULFPORT
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State | MS
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Zip | 39503
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Country | US
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Telephone | 228-832-1832
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Fax |
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Provider Business Mailing Address
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Address Line | 7412 OLD FORT BAYOU RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-8195
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Country | US
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Telephone | 228-238-8687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1082
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License Number State | MS
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