Provider Demographics
NPI:1477556231
Name:UNIVERSITY OPHTHALMOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY OPHTHALMOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHING
Authorized Official - Middle Name:JYGH
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:601-984-5022
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:STE B329
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-3931
Mailing Address - Fax:601-815-3773
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:STE B329
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-3931
Practice Address - Fax:601-815-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08640207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015396Medicaid
MS09015396Medicaid