Provider Demographics
NPI:1427208941
Name:BRIAN S CALLAHAN O.D. INC.
Entity Type:Organization
Organization Name:BRIAN S CALLAHAN O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-932-1890
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-1304
Mailing Address - Country:US
Mailing Address - Phone:601-932-1890
Mailing Address - Fax:601-932-3119
Practice Address - Street 1:5520 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8926
Practice Address - Country:US
Practice Address - Phone:601-932-1890
Practice Address - Fax:601-932-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03755233Medicaid
MSU57480Medicare UPIN
MS410000127Medicare PIN