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General NPI Number Information
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NPI Number | 1780789172
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Entity Type | Organization
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Legal Business Name | EYEDOK LLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 6137 AUTUMN PT
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6643
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Country | US
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Telephone | 901-438-6088
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Fax |
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Provider Business Mailing Address
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Address Line | 6137 AUTUMN PT
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6643
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Country | US
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Telephone | 901-438-6088
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | DR. PATRICIA R OKELLEY HUGHES
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Credential | O.D.
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Telephone | 901-438-6088
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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 | 751
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License Number State | MS
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