Provider Demographics
NPI:1043993678
Name:MS EYE CARE PA
Entity Type:Organization
Organization Name:MS EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-773-3494
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-0628
Mailing Address - Country:US
Mailing Address - Phone:662-446-9000
Mailing Address - Fax:
Practice Address - Street 1:504 EASEL ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MS
Practice Address - Zip Code:38673-1003
Practice Address - Country:US
Practice Address - Phone:662-234-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MS EYE CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty