Provider Demographics
NPI:1518631365
Name:PACE, JEFFERY MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:MARTIN
Last Name:PACE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 AIRPORT RD S
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-6654
Mailing Address - Country:US
Mailing Address - Phone:601-939-3753
Mailing Address - Fax:601-936-6586
Practice Address - Street 1:100 AIRPORT RD S
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-6654
Practice Address - Country:US
Practice Address - Phone:601-939-3753
Practice Address - Fax:601-936-6586
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist