Provider Demographics
NPI:1437181088
Name:JULIE C. BROCK, O.D., INC.
Entity Type:Organization
Organization Name:JULIE C. BROCK, O.D., INC.
Other - Org Name:THE EYE CLINIC OF SALTILLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-869-1779
Mailing Address - Street 1:PO BOX 1055
Mailing Address - Street 2:107 TOWN CREEK DRIVE
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-1055
Mailing Address - Country:US
Mailing Address - Phone:662-869-1779
Mailing Address - Fax:662-869-3776
Practice Address - Street 1:107 TOWN CREEK DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866
Practice Address - Country:US
Practice Address - Phone:662-869-1779
Practice Address - Fax:662-869-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty