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General NPI Number Information
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NPI Number | 1437372885
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Entity Type | Organization
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Legal Business Name | TOTAL EYE CARE CLINIC OF PHILADELPHIA, INC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 1003 E MAIN ST
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City | PHILADELPHIA
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State | MS
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Zip | 39350-2307
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Country | US
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Telephone | 601-656-2688
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Fax | 601-656-8454
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Provider Business Mailing Address
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Address Line | 1003 E MAIN ST
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City | PHILADELPHIA
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State | MS
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Zip | 39350-2307
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Country | US
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Telephone | 601-656-2688
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Fax | 601-656-8454
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. TOMMY L LATIMER
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Credential |
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Telephone | 601-656-2688
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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 | 503
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License Number State | MS
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