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General NPI Number Information
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NPI Number | 1871763524
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Entity Type | Organization
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Legal Business Name | R. D. EASON OD PA
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 516 AIRPORT RD
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City | FOREST
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State | MS
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Zip | 39074-4032
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Country | US
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Telephone | 601-469-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 516 AIRPORT RD
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City | FOREST
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State | MS
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Zip | 39074-4032
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Country | US
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Telephone | 601-469-2020
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JANICE E EASON
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Credential |
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Telephone | 601-469-2020
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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 | 481
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License Number State | MS
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