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General NPI Number Information
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NPI Number | 1417270943
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Entity Type | Organization
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Legal Business Name | GRACIE PLLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 2005 W MAIN ST
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City | TUPELO
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State | MS
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Zip | 38801-3214
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Country | US
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Telephone | 662-205-4654
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 W MAIN ST
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City | TUPELO
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State | MS
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Zip | 38801-3214
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Country | US
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Telephone | 662-205-4654
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. THOMAS S POWELL JR.
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Credential | O.D.
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Telephone | 662-205-4654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 0525
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License Number State | MS
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