Provider Demographics
NPI:1083659684
Name:HELLUMS, MICHAEL SHAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:HELLUMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:HELLUMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-0557
Mailing Address - Country:US
Mailing Address - Phone:662-561-1234
Mailing Address - Fax:662-729-4510
Practice Address - Street 1:205 HOUSE CARLSON DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-7643
Practice Address - Country:US
Practice Address - Phone:662-561-1234
Practice Address - Fax:662-729-4510
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03734792Medicaid
MSU82173Medicare UPIN
MS03734792Medicaid
MS410000360Medicare PIN