Eye Clinic Of Eupora, Inc | |
3126 E Roane Ave, Eupora, MS 39744-2638 | |
(662) 258-2020 | |
(662) 258-2030 |
Full Name | Eye Clinic Of Eupora, Inc |
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Type | Facility |
Speciality | Optometrist |
Location | 3126 E Roane Ave, Eupora, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1033240825 | NPI | - | NPPES |
09014730 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 519 (Mississippi) | Primary |
Provider Name | Charles P Tillman |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1275630626 PECOS PAC ID: 6204905847 Enrollment ID: I20080521000902 |
Provider Name | Stacie L Moore |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1477662138 PECOS PAC ID: 3072677103 Enrollment ID: I20110315001061 |
Provider Name | Taylor Elizabeth O'daniel |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1689354417 PECOS PAC ID: 4880058791 Enrollment ID: I20230912000116 |
Mailing Address | Practice Location Address |
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Eye Clinic Of Eupora, Inc Po Box 225, Eupora, MS 39744-0225 Ph: (662) 258-2020 | Eye Clinic Of Eupora, Inc 3126 E Roane Ave, Eupora, MS 39744-2638 Ph: (662) 258-2020 |
Dr. Charles P Tillman Jr., O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 3126 E Roane Ave, Eupora, MS 39744 Phone: 662-258-2020 Fax: 662-258-2030 | |
Taylor Elizabeth O'daniel, Optometrist Medicare: Medicare Enrolled Practice Location: 3126 E Roane Ave, Eupora, MS 39744 Phone: 662-258-2020 |