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General NPI Number Information
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NPI Number | 1538337902
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Entity Type | Organization
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Legal Business Name | TRI COUNTY EYE CLINIC, PLLC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 15122 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-3120
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Country | US
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Telephone | 228-832-1242
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Fax | 228-832-1285
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Provider Business Mailing Address
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Address Line | 15122 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-3120
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Country | US
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Telephone | 228-832-1242
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Fax | 228-832-1285
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Authorized Official
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Title or Position | OWNER/OPHTHALMOLOGIST
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Name | DR. GREGORY EMILE BERTUCCI
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Credential | M.D.
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Telephone | 228-385-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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