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General NPI Number Information
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NPI Number | 1649675364
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Entity Type | Organization
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Legal Business Name | MAURICE JAMES OPHTHALMOLOGY, PA
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 971 LAKELAND DR SUITE 563
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City | JACKSON
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State | MS
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Zip | 39216-4643
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Country | US
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Telephone | 601-362-4467
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Fax | 601-362-0239
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Provider Business Mailing Address
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Address Line | 971 LAKELAND DR SUITE 563
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City | JACKSON
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State | MS
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Zip | 39216-4643
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Country | US
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Telephone | 601-362-4467
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Fax | 601-362-0239
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MICHELE IVY
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Credential |
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Telephone | 601-362-4467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 8996
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License Number State | MS
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