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General NPI Number Information
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NPI Number | 1538351101
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Entity Type | Organization
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Legal Business Name | EDGEWATER EYECARE, INC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 2318 PASS RD STE 1
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City | BILOXI
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State | MS
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Zip | 39531-4044
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Country | US
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Telephone | 228-388-1115
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Fax | 228-388-1511
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Provider Business Mailing Address
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Address Line | 2318 PASS RD STE 1
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City | BILOXI
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State | MS
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Zip | 39531-4044
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Country | US
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Telephone | 228-388-1115
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Fax | 228-388-1511
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHRIS K RAINS
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Credential | OD
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Telephone | 228-388-1115
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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 | 567
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License Number State | MS
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