Provider Demographics
NPI:1467832733
Name:MASSEY, EVELYN LUCILE (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:LUCILE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHRIS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-9383
Mailing Address - Country:US
Mailing Address - Phone:662-645-4545
Mailing Address - Fax:662-358-4407
Practice Address - Street 1:500 CHRIS RD
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-9383
Practice Address - Country:US
Practice Address - Phone:662-645-4545
Practice Address - Fax:662-358-4407
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16605207W00000X
TXK9609207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology