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General NPI Number Information
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NPI Number | 1427002864
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Entity Type | Organization
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Legal Business Name | THE EYE CLINIC PA
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 1900 23RD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2965
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Country | US
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Telephone | 228-864-2633
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Fax | 228-865-0339
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | GULFPORT
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State | MS
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Zip | 39502-0148
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Country | US
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Telephone | 228-864-2633
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Fax | 228-865-0339
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM C SAMS III
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Credential | M.D.
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Telephone | 228-864-2633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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