| |
1021 East St, Mendenhall, MS 39114-3107 | |
(601) 847-1232 | |
(601) 847-1376 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 1021 East St, Mendenhall, Mississippi |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184742843 | NPI | - | NPPES |
C03245 | Other | MS | GROUP SUPPLIER CODE |
00087015 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 423 (Mississippi) | Primary |
Mailing Address | Practice Location Address |
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P. O. Box 577, Mendenhall, MS 39114-3107 Ph: (601) 847-1232 | 1021 East St, Mendenhall, MS 39114-3107 Ph: (601) 847-1232 |