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General NPI Number Information
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NPI Number | 1982633152
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Entity Type | Organization
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Legal Business Name | SOUTHAVEN VISION CENTER, INC.
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 484 CHURCH RD.
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9714
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Country | US
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Telephone | 662-349-3737
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Fax | 662-349-2828
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Provider Business Mailing Address
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Address Line | 484 CHURCH RD.
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9714
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Country | US
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Telephone | 662-349-3737
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Fax | 662-349-2828
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. SHAWN HELLUMS
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Credential | O.D.
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Telephone | 662-349-3737
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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 |
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License Number State |
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