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General NPI Number Information
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NPI Number | 1801170287
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Entity Type | Organization
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Legal Business Name | BELLIPANNI EYE CLINIC, PLLC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 05/18/2017
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Provider Practice Location Address
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Address Line | 104 S MARTIN LUTHER KING JR DR
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City | INDIANOLA
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State | MS
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Zip | 38751-2366
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Country | US
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Telephone | 662-887-3120
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Fax | 662-887-3291
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Provider Business Mailing Address
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Address Line | 104 S MARTIN LUTHER KING JR DR
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City | INDIANOLA
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State | MS
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Zip | 38751-2366
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Country | US
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Telephone | 662-887-3120
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW BELLIPANNI
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Credential | O.D.
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Telephone | 662-887-3120
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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 | 843
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License Number State | MS
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