| NPI | 1013256411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GUIDRY Office Manager 601-366-9020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 783) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MS 783) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2014-08-15 |