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General NPI Number Information
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NPI Number | 1962800011
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Entity Type | Organization
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Legal Business Name | POPLARVILLE EYE CLINIC, LLC
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 1716 S MAIN ST
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City | POPLARVILLE
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State | MS
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Zip | 39470-4287
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Country | US
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Telephone | 601-795-0137
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Fax | 601-795-0148
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Provider Business Mailing Address
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Address Line | PO BOX 521
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City | POPLARVILLE
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State | MS
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Zip | 39470-0521
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Country | US
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Telephone | 601-795-0137
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Fax | 601-795-0148
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. BETHANY G. HARRINGTON
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Credential | OD
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Telephone | 601-795-0137
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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 | 685
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License Number State | MS
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