Provider Demographics
NPI:1447794797
Name:OPTICAL 2000 OF FLORA PA
Entity Type:Organization
Organization Name:OPTICAL 2000 OF FLORA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-879-5550
Mailing Address - Street 1:115 CYNTHIA ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3711
Mailing Address - Country:US
Mailing Address - Phone:601-924-4444
Mailing Address - Fax:601-924-4100
Practice Address - Street 1:4843 MAIN ST.
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071
Practice Address - Country:US
Practice Address - Phone:601-879-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTICAL 2000 PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-06
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00748152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty