| NPI | 1003055872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK H ALLEN Owner/Optometrist 601-939-6366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 621) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MS 621) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2014-07-03 |