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General NPI Number Information
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NPI Number | 1770044497
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Entity Type | Organization
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Legal Business Name | TRI COUNTY EYE CLINIC, PLLC
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 05/25/2025
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Provider Practice Location Address
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Address Line | 3430 BIENVILLE BOULEVARD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-5732
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Country | US
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Telephone | 228-875-6658
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Fax | 228-875-0809
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Provider Business Mailing Address
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Address Line | 431 BERTUCCI BOULEVARD
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City | BILOXI
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State | MS
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Zip | 39531-2255
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Country | US
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Telephone | 228-385-2020
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Fax | 228-388-9435
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Authorized Official
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Title or Position | OWNER/OPHTHALMOLOGIST
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Name | DR. GREGORY EMILE BERTUCCI
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Credential | M.D.
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Telephone | 228-385-2020
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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 |
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License Number State |
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Taxonomy #2
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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 |
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