MEDICARE: TOTAL EYE CARE CLINIC OF PHILADELPHIA, INC

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	503	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437372885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL EYE CARE CLINIC OF PHILADELPHIA, INC

Provider Business Mailing Address
First Line	:	1003 E MAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2307
Country	:	US
Telephone Number	:	601-656-2688
Fax Number	:	601-656-8454

Provider Business Practice Location Address
First Line	:	1003 E MAIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2307
Country	:	US
Telephone Number	:	601-656-2688
Fax Number	:	601-656-8454

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. TOMMY L LATIMER
Credential	:
Telephone Number	:	601-656-2688

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	04/08/2016

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