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General NPI Number Information
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NPI Number | 1740357334
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI RETINA ASSOCIATES,PLLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 1026 BAPTIST CIR STE 400
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City | MADISON
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State | MS
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Zip | 39110-2028
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Country | US
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Telephone | 601-981-4091
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Fax | 601-981-5039
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Provider Business Mailing Address
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Address Line | 1200 N STATE ST SUITE 300
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City | JACKSON
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State | MS
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Zip | 39202-2001
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Country | US
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Telephone | 601-981-4091
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Fax | 601-981-5039
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL JUDE BORNE
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Credential |
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Telephone | 601-981-4091
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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 |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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