Provider Demographics
NPI:1477271377
Name:ODOMS EYE CARE CENTRAL
Entity Type:Organization
Organization Name:ODOMS EYE CARE CENTRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELLIA
Authorized Official - Middle Name:SALONE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-673-0714
Mailing Address - Street 1:1860 CHADWICK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3465
Mailing Address - Country:US
Mailing Address - Phone:601-673-0714
Mailing Address - Fax:601-373-4311
Practice Address - Street 1:1860 CHADWICK DR STE 103
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3465
Practice Address - Country:US
Practice Address - Phone:601-673-0714
Practice Address - Fax:601-373-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty