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General NPI Number Information
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NPI Number | 1497931877
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Entity Type | Organization
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Legal Business Name | ANDERSON'S OPTIQUE, INC.
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 4800 I 55 N
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City | JACKSON
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State | MS
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Zip | 39211-5555
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Country | US
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Telephone | 601-948-0582
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Fax | 601-362-1392
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Provider Business Mailing Address
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Address Line | 4800 I 55 N
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City | JACKSON
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State | MS
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Zip | 39211-5555
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Country | US
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Telephone | 601-948-0582
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Fax | 601-362-1392
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARY JULIA ANDERSON
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Credential |
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Telephone | 601-948-0582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number | UNLICENSED STATE
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License Number State | MS
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