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General NPI Number Information
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NPI Number | 1902156987
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Entity Type | Organization
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Legal Business Name | CASS L. CLEMENTS, O.D., LLC
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 1200 E COUNTY LINE RD STE 164
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City | RIDGELAND
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State | MS
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Zip | 39157-1904
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Country | US
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Telephone | 601-956-6557
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Fax | 601-956-6559
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Provider Business Mailing Address
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Address Line | 1200 E COUNTY LINE RD STE 164
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City | RIDGELAND
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State | MS
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Zip | 39157-1904
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Country | US
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Telephone | 601-956-6557
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Fax | 601-956-6559
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Authorized Official
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Title or Position | OWNER
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Name | DR. CASS L CLEMENTS
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Credential | O.D.
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Telephone | 601-956-6557
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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 | 641
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License Number State | MS
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