Provider Demographics
NPI:1174635700
Name:BATESVILLE VISION CLINIC
Entity Type:Organization
Organization Name:BATESVILLE VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-563-9880
Mailing Address - Street 1:365 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2311
Mailing Address - Country:US
Mailing Address - Phone:662-563-9880
Mailing Address - Fax:662-563-9882
Practice Address - Street 1:365 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2311
Practice Address - Country:US
Practice Address - Phone:662-563-9880
Practice Address - Fax:662-563-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS736152W00000X
MS535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02152701Medicaid
MS02152701Medicaid
MS5538870001Medicare NSC
MSC03398Medicare ID - Type UnspecifiedMEDICARE NUMBER