| |
3027 Jefferson St, Macon, MS 39341-2275 | |
(662) 726-6111 | |
(662) 726-6110 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 3027 Jefferson St, Macon, Mississippi |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184737017 | NPI | - | NPPES |
05208871 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 517 (Mississippi) | Primary |
152W00000X | Optometrist | 762 (Mississippi) | Secondary |
152W00000X | Optometrist | 560 (Mississippi) | Secondary |
Mailing Address | Practice Location Address |
---|---|
Po Box 826, Philadelphia, MS 39350-0826 Ph: (662) 446-9000 | 3027 Jefferson St, Macon, MS 39341-2275 Ph: (662) 726-6111 |
Royce Vandiver Miles Jr., Optometrist Medicare: Accepting Medicare Assignments Practice Location: 3027 Jefferson St, Macon, MS 39341 Phone: 662-726-6111 Fax: 662-726-6110 |