| NPI | 1043716665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PATRICK COLEMAN Administrator 662-286-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MS 19893) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 06029) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2022-10-06 |