Provider Demographics
NPI:1346521119
Name:BELLIPANNI, MATTHEW BARNES (OD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BARNES
Last Name:BELLIPANNI
Suffix:
Gender:M
Credentials:OD
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Other - First Name:
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Mailing Address - Street 1:104 S MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2366
Mailing Address - Country:US
Mailing Address - Phone:662-836-7950
Mailing Address - Fax:662-247-4092
Practice Address - Street 1:104 S MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2366
Practice Address - Country:US
Practice Address - Phone:662-887-3120
Practice Address - Fax:662-887-3291
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist