Provider Demographics
NPI:1346385762
Name:SOUTHWEST MISSISSIPPI EYE CENTER
Entity Type:Organization
Organization Name:SOUTHWEST MISSISSIPPI EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-684-3112
Mailing Address - Street 1:414B MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2710
Mailing Address - Country:US
Mailing Address - Phone:601-684-3112
Mailing Address - Fax:601-249-3210
Practice Address - Street 1:414B MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2710
Practice Address - Country:US
Practice Address - Phone:601-684-3112
Practice Address - Fax:601-249-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21180207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05230868Medicaid
CN5707Medicare PIN
MS05230868Medicaid
MSC02383Medicare PIN