Provider Demographics
NPI:1164670329
Name:TALLAHATCHIE EYECARE, PLLC
Entity Type:Organization
Organization Name:TALLAHATCHIE EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-647-3500
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-0200
Mailing Address - Country:US
Mailing Address - Phone:662-647-3500
Mailing Address - Fax:
Practice Address - Street 1:203 S MARKET ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2236
Practice Address - Country:US
Practice Address - Phone:662-647-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty