Provider Demographics
NPI:1114448800
Name:MEGAN SUMRALL, OD, PLLC
Entity Type:Organization
Organization Name:MEGAN SUMRALL, OD, PLLC
Other - Org Name:BELLE VUE SPECIALTY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-475-2020
Mailing Address - Street 1:7117 US HWY 98
Mailing Address - Street 2:SUITE 30
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-475-2020
Mailing Address - Fax:800-493-5956
Practice Address - Street 1:7127 HIGHWAY 98
Practice Address - Street 2:SUITE 30
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-470-2020
Practice Address - Fax:800-493-5956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEGAN SUMRALL, OD, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS760152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty