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NPI Code Detail

MEDICARE: HATTIESBURG EYE CLINIC, P.A.

MEDICARE: HATTIESBURG EYE CLINIC, P.A.
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1538369996
Entity Type Code : Organization
Provider Name (Legal Business Name) : HATTIESBURG EYE CLINIC, P.A.
Provider Business Mailing Address
First Line : 100 HOSPITAL DR W
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1334
Country : US
Telephone Number : 601-268-5910
Fax Number : 601-264-0659
Provider Business Practice Location Address
First Line : 1621 HIGHWAY 15 N
Second Line :
City : LAUREL
State : MS
Zip : 39440-2123
Country : US
Telephone Number : 601-518-3937
Fax Number :
Authorized Official
Title or Position : ADMINISTRATIVE ASSISTANT
Name : EDDIE SMITH
Credential :
Telephone Number : 601-268-5910
Provider Enumeration Date : 07/23/2007
Last Update Date : 07/24/2007

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Directions to “HATTIESBURG EYE CLINIC, P.A. ” Practice Location

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