Provider Demographics
NPI:1053506683
Name:CORINTH EYE CLINIC, INC
Entity Type:Organization
Organization Name:CORINTH EYE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-286-8860
Mailing Address - Street 1:3201 GAINES RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8422
Mailing Address - Country:US
Mailing Address - Phone:662-286-8860
Mailing Address - Fax:662-286-3079
Practice Address - Street 1:3201 GAINES RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-8422
Practice Address - Country:US
Practice Address - Phone:662-286-8860
Practice Address - Fax:662-286-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01507367Medicaid
MS0733560001Medicare NSC