Provider Demographics
NPI:1093020893
Name:JOSHUA E. BOSTICK, O.D., P.A.
Entity Type:Organization
Organization Name:JOSHUA E. BOSTICK, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BOSTICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-869-1779
Mailing Address - Street 1:107 TOWN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-7947
Mailing Address - Country:US
Mailing Address - Phone:662-869-1779
Mailing Address - Fax:662-869-3776
Practice Address - Street 1:107 TOWN CREEK DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-7947
Practice Address - Country:US
Practice Address - Phone:662-869-1779
Practice Address - Fax:662-869-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07622573Medicaid
302I417390Medicare PIN
302G414318Medicare UPIN