Provider Demographics
NPI:1255323903
Name:POWELL, THOMAS S JR (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607B EARL FRYE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5503
Mailing Address - Country:US
Mailing Address - Phone:662-256-9711
Mailing Address - Fax:662-256-1047
Practice Address - Street 1:607B EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5503
Practice Address - Country:US
Practice Address - Phone:662-256-9711
Practice Address - Fax:662-256-1047
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS0525152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087005Medicaid
MS560000025Medicare PIN
MST20932Medicare UPIN
MS0393260001Medicare NSC