| |
1827 C Simpson Highway 149, Mendenhall, MS 39114-3439 | |
(601) 847-6600 | |
(601) 847-6606 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 1827 C Simpson Highway 149, Mendenhall, Mississippi |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1760739064 | NPI | - | NPPES |
00087046 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 420 (Mississippi) | Primary |
Mailing Address | Practice Location Address |
---|---|
1827 C Simpson Highway 149, Mendenhall, MS 39114-3439 Ph: (601) 847-6600 | 1827 C Simpson Highway 149, Mendenhall, MS 39114-3439 Ph: (601) 847-6600 |