MEDICARE: HOLLY SPRINGS EYECARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1235821216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLY SPRINGS EYECARE PLLC

Provider Business Mailing Address
First Line	:	302 RAILROAD ST
Second Line	:
City	:	WATER VALLEY
State	:	MS
Zip	:	38965-3032
Country	:	US
Telephone Number	:	662-473-2181
Fax Number	:	662-473-2161

Provider Business Practice Location Address
First Line	:	302 RAILROAD ST
Second Line	:
City	:	WATER VALLEY
State	:	MS
Zip	:	38965-3032
Country	:	US
Telephone Number	:	662-473-2181
Fax Number	:	662-473-2161

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN PATRICK EDWARDS
Credential	:	OD
Telephone Number	:	662-473-2181

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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