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General NPI Number Information
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NPI Number | 1942487558
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Entity Type | Organization
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Legal Business Name | ROUTT EYE CLINIC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 107 S NATCHEZ ST
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City | KOSCIUSKO
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State | MS
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Zip | 39090-3741
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Country | US
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Telephone | 662-289-4131
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Fax | 662-289-5348
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Provider Business Mailing Address
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Address Line | 107 S NATCHEZ ST
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City | KOSCIUSKO
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State | MS
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Zip | 39090-3741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LAWRENCE ADRIAN ROUTT
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Credential | O.D.
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Telephone | 662-289-4131
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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 | 471
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License Number State | MS
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