Provider Demographics
NPI:1518027937
Name:ODOM'S OPTICAL LLC
Entity Type:Organization
Organization Name:ODOM'S OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ODOM
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:601-939-6366
Mailing Address - Street 1:PO BOX 321443
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1443
Mailing Address - Country:US
Mailing Address - Phone:601-939-6366
Mailing Address - Fax:601-982-4400
Practice Address - Street 1:4806 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8694
Practice Address - Country:US
Practice Address - Phone:601-939-6366
Practice Address - Fax:601-982-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5372120001Medicare ID - Type Unspecified