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General NPI Number Information
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NPI Number | 1811364698
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Entity Type | Organization
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Legal Business Name | PRECISION OPTICAL DISPENSARY, INC
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 4339 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8947
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Country | US
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Telephone | 601-936-5827
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Fax | 601-936-3822
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Provider Business Mailing Address
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Address Line | 4339 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8947
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Country | US
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Telephone | 601-936-5827
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Fax | 601-936-3822
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLYN HARRIS
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Credential |
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Telephone | 601-936-5827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | MS
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