MEDICARE: RIDGELAND EYECARE CENTER

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	623	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	:	1881744282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGELAND EYECARE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 2790
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39158-2790
Country	:	US
Telephone Number	:	601-957-8444
Fax Number	:	601-956-7147

Provider Business Practice Location Address
First Line	:	8 PROFESSIONAL PKWY
Second Line	:	SUITE A
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4113
Country	:	US
Telephone Number	:	601-957-8444
Fax Number	:	601-956-7147

Authorized Official
Title or Position	:	PRESIDENT AND OPTOMETRIST
Name	:	DR. ARTHUR REGINALD DAMPIER JR.
Credential	:	O.D.
Telephone Number	:	601-957-8444

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	06/10/2009

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