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General NPI Number Information
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NPI Number | 1396907648
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Entity Type | Organization
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Legal Business Name | GLEN H STRIBLING OD
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 5602 I 55 S
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City | BYRAM
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State | MS
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Zip | 39272-9402
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Country | US
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Telephone | 601-372-5914
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Fax | 601-372-5921
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Provider Business Mailing Address
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Address Line | 5602 I 55 S
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City | BYRAM
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State | MS
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Zip | 39272-9402
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Country | US
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Telephone | 601-372-5914
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Fax | 601-372-5921
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHIRLEY A SHELTON
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Credential |
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Telephone | 601-372-5914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 516
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License Number State | MS
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