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General NPI Number Information
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NPI Number | 1598884975
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Entity Type | Organization
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Legal Business Name | DAN WINDHAM OPTICAL, INC.
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 2630 HWY 80 EAST
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City | PEARL
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State | MS
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Zip | 39208
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Country | US
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Telephone | 601-939-1981
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Fax | 601-939-1981
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Provider Business Mailing Address
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Address Line | 2630 HWY 80 EAST
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City | PEARL
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State | MS
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Zip | 39208
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Country | US
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Telephone | 601-939-1981
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Fax | 601-939-3357
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHERYL WINDHAM
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Credential |
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Telephone | 601-939-1981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 061087102
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License Number State | MS
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