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General NPI Number Information
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NPI Number | 1477556231
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OPHTHALMOLOGY ASSOCIATES
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 2500 N STATE ST STE B329
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-3931
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Fax | 601-815-3773
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST STE B329
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-3931
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Fax | 601-815-3773
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CHING JYGH CHEN
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Credential | M. D.
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Telephone | 601-984-5022
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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 | 08640
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License Number State | MS
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