Provider Demographics
NPI:1154833572
Name:OXFORD EYE CLINIC & OPTICAL, PLLC
Entity Type:Organization
Organization Name:OXFORD EYE CLINIC & OPTICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SHELTON
Authorized Official - Last Name:WALLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-341-1399
Mailing Address - Street 1:2167 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5223
Mailing Address - Country:US
Mailing Address - Phone:662-234-6683
Mailing Address - Fax:662-234-4413
Practice Address - Street 1:2167 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5223
Practice Address - Country:US
Practice Address - Phone:662-234-6683
Practice Address - Fax:662-234-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty