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General NPI Number Information
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NPI Number | 1346334554
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Entity Type | Organization
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Legal Business Name | MS EYE CARE, PA
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 1054 AIRPARK RD
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3368
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Country | US
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Telephone | 601-656-3296
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Fax | 601-656-8164
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Provider Business Mailing Address
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Address Line | PO BOX 628
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City | PHILADELPHIA
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State | MS
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Zip | 39350
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Country | US
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Telephone | 662-446-9000
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Fax | 662-779-4030
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Authorized Official
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Title or Position | OD/OWNER
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Name | JACOB A IVEY
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Credential | OD
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Telephone | 601-656-3296
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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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