Provider Demographics
NPI:1225196736
Name:CHERYL AND STEVE INC.
Entity Type:Organization
Organization Name:CHERYL AND STEVE INC.
Other - Org Name:GIBSON OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-425-3173
Mailing Address - Street 1:1620 HIGHWAY 15 N STE A
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1892
Mailing Address - Country:US
Mailing Address - Phone:601-425-3173
Mailing Address - Fax:601-425-3094
Practice Address - Street 1:1620 HIGHWAY 15 N STE A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1892
Practice Address - Country:US
Practice Address - Phone:601-425-3173
Practice Address - Fax:601-425-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880089Medicaid
MS00880089Medicaid