Provider Demographics
NPI:1306010897
Name:TINA SOREY DOCTOR OF OPTOMETRY, PA
Entity Type:Organization
Organization Name:TINA SOREY DOCTOR OF OPTOMETRY, PA
Other - Org Name:SOREY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SOREY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-992-7275
Mailing Address - Street 1:117 LUCKNEY STATION
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8027
Mailing Address - Country:US
Mailing Address - Phone:601-992-7275
Mailing Address - Fax:601-992-7244
Practice Address - Street 1:117 LUCKNEY STATION
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8027
Practice Address - Country:US
Practice Address - Phone:601-992-7275
Practice Address - Fax:601-992-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015291Medicaid
MS09015291Medicaid