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General NPI Number Information
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NPI Number | 1326394677
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Entity Type | Organization
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Legal Business Name | TAYLORSVILLE EYE CARE LLC
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 300 PINE ST
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-5432
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Country | US
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Telephone | 601-785-0111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1280
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-1280
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE
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Name | TAMMY WOMBLE
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Credential |
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Telephone | 601-785-0111
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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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