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General NPI Number Information
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NPI Number | 1487915831
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Entity Type | Organization
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Legal Business Name | RONALD MOZINGO, OD, LLC
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 6096 U S HIGHWAY 98 SUITE 1-A
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City | HATTIESBURG
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State | MS
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Zip | 39402-8885
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Country | US
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Telephone | 601-261-2467
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Fax | 601-296-6685
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Provider Business Mailing Address
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Address Line | 6096 U S HIGHWAY 98 SUITE 1-A
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City | HATTIESBURG
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State | MS
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Zip | 39402-8885
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Country | US
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Telephone | 601-261-2467
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Fax | 601-296-6685
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Authorized Official
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Title or Position | MANAGER
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Name | GINGER KEEN
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Credential |
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Telephone | 601-261-2467
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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 | 826
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License Number State | MS
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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 | 470
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License Number State | MS
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