MEDICARE: FRANK EVANS JR.

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	448	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	:	1972517506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK EVANS JR.

Provider Business Mailing Address
First Line	:	PO BOX 139
Second Line	:
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916-0139
Country	:	US
Telephone Number	:	662-628-5139
Fax Number	:	662-628-1974

Provider Business Practice Location Address
First Line	:	400 NORTH MAIN STEET
Second Line	:
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916-0139
Country	:	US
Telephone Number	:	662-628-5139
Fax Number	:	662-628-1974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	10/28/2010

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Directions to “ FRANK EVANS JR. ” Practice Location

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