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General NPI Number Information
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NPI Number | 1427208941
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Entity Type | Organization
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Legal Business Name | BRIAN S CALLAHAN O.D. INC.
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 5520 HIGHWAY 80 E
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City | PEARL
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State | MS
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Zip | 39208-8926
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Country | US
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Telephone | 601-932-1890
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Fax | 601-932-3119
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Provider Business Mailing Address
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Address Line | PO BOX 1304
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City | BRANDON
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State | MS
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Zip | 39043-1304
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Country | US
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Telephone | 601-932-1890
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Fax | 601-932-3119
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BRIAN S CALLAHAN
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Credential | O.D.
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Telephone | 601-932-1890
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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 | 590
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License Number State | MS
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