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General NPI Number Information
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NPI Number | 1639611619
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Entity Type | Organization
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Legal Business Name | EYES2SEE, P.A.
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 109 STATE HIGHWAY 15 S
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City | NEW ALBANY
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State | MS
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Zip | 38652-5206
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Country | US
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Telephone | 662-534-9288
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Fax | 662-534-8341
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Provider Business Mailing Address
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Address Line | PO BOX 510
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City | NEW ALBANY
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State | MS
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Zip | 38652-0510
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Country | US
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Telephone | 662-534-9288
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Fax | 662-534-8341
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | DR. JULIE C. BROCK
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Credential | O.D.
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Telephone | 662-316-3761
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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 | 661
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License Number State | MS
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