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General NPI Number Information
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NPI Number | 1922279959
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Entity Type | Organization
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Legal Business Name | NATCHEZ OPITAL
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 453 JOHN R JUNKIN DR
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City | NATCHEZ
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State | MS
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Zip | 39120-3825
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Country | US
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Telephone | 601-445-2164
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Fax | 318-446-8185
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Provider Business Mailing Address
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Address Line | 453 JOHN R JUNKIN DR
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City | NATCHEZ
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State | MS
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Zip | 39120-3825
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Country | US
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Telephone | 601-445-2164
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Fax | 318-446-8185
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Authorized Official
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Title or Position | MD
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Name | PATRICK A DUFFY
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Credential | MD
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Telephone | 601-445-2164
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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 | 07891
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License Number State | MS
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