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General NPI Number Information
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NPI Number | 1619317377
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Entity Type | Organization
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Legal Business Name | CAGLE EYE CENTER
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 402 ACCESS RD
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City | FULTON
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State | MS
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Zip | 38843-6607
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Country | US
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Telephone | 662-231-0427
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67
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City | FULTON
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State | MS
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Zip | 38843-0067
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Country | US
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Telephone | 662-231-0427
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. LAURIE CAGLE
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Credential | O.D.
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Telephone | 662-231-0427
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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 | 740
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License Number State | MS
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