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General NPI Number Information
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NPI Number | 1740615996
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Entity Type | Organization
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Legal Business Name | LELAND EYE CLINIC, PLLC
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 206 BAKER BLVD
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City | LELAND
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State | MS
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Zip | 38756-3402
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Country | US
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Telephone | 662-686-2020
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Fax | 662-686-2020
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Provider Business Mailing Address
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Address Line | 206 BAKER BLVD
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City | LELAND
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State | MS
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Zip | 38756-3402
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Country | US
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Telephone | 662-686-2020
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Fax | 662-686-2020
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TODD HALL
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Credential | O.D.
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Telephone | 662-686-2020
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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 | 570
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License Number State | MS
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