MEDICARE: COLEMAN EYE CENTER, 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	207W00000X	Ophthalmology Physician		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4181580001	OTHER	MS	CIGNA GOVERNMENT SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528066644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLEMAN EYE CENTER, PLLC

Provider Business Mailing Address
First Line	:	2005 HIGHWAY 82 W
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-2720
Country	:	US
Telephone Number	:	662-455-4523
Fax Number	:	662-455-3790

Provider Business Practice Location Address
First Line	:	2005 HIGHWAY 82 W
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-2720
Country	:	US
Telephone Number	:	662-455-4523
Fax Number	:	662-455-3790

Authorized Official
Title or Position	:	INSURANCE REPRESENTATIVE
Name	:	TARA E KELLY
Credential	:
Telephone Number	:	662-455-4523

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/21/2022

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