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General NPI Number Information
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NPI Number | 1952310492
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Entity Type | Organization
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Legal Business Name | 2020 VISION CENTER, PA
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 499 GLOSTER CREEK VILLAGE SUITE F3
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City | TUPELO
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State | MS
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Zip | 38801-4631
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Country | US
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Telephone | 662-350-3676
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Fax | 662-269-2601
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Provider Business Mailing Address
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Address Line | 499 GLOSTER CREEK VILLAGE SUITE F3
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City | TUPELO
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State | MS
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Zip | 38801-4631
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Country | US
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Telephone | 662-350-3676
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Fax | 662-269-2601
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MAURICE ALLAN CLARK
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Credential | OD
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Telephone | 662-350-3676
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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 | 730
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License Number State | MS
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