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General NPI Number Information
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NPI Number | 1366837262
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Entity Type | Organization
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Legal Business Name | TOTAL ICARE MS LLC
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1200 E COUNTY LINE RD STE 164
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City | RIDGELAND
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State | MS
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Zip | 39157-1904
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Country | US
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Telephone | 769-208-8930
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Fax | 769-208-8831
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Provider Business Mailing Address
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Address Line | PO BOX 2355
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City | RIDGELAND
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State | MS
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Zip | 39158-2355
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Country | US
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Telephone | 769-208-8930
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Fax | 769-208-8831
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Authorized Official
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Title or Position | OWNER
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Name | DR. COURTNEY THOMPSON
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Credential | O.D.
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Telephone | 601-212-8162
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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 | 867
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License Number State | MS
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