Provider Demographics
NPI:1407825037
Name:BARNES CROSSING VISION CENTER P. A.
Entity Type:Organization
Organization Name:BARNES CROSSING VISION CENTER P. A.
Other - Org Name:TUPELO VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:662-243-2600
Mailing Address - Street 1:1028 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1924
Mailing Address - Country:US
Mailing Address - Phone:662-840-4624
Mailing Address - Fax:
Practice Address - Street 1:3929 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0915
Practice Address - Country:US
Practice Address - Phone:662-840-4624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS487152W00000X
MSTPA 94061152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03888791Medicaid
MS03888791Medicaid