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General NPI Number Information
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NPI Number | 1679515464
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Entity Type | Organization
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Legal Business Name | PATTON FAMILY OPTOMETRY, INC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 120 DISTRICT BLVD STE D109
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City | JACKSON
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State | MS
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Zip | 39211
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Country | US
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Telephone | 601-398-4662
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Fax | 601-398-4669
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Provider Business Mailing Address
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Address Line | 120 DISTRICT BLVD STE D109
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City | JACKSON
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State | MS
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Zip | 39211-6382
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Country | US
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Telephone | 601-398-4662
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Fax | 601-398-4669
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA COX PATTON
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Credential | OD
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Telephone | 601-398-4662
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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 | MS663
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License Number State | MS
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