Provider Demographics
NPI:1528360377
Name:TAYLOR EYECARE, INC.
Entity Type:Organization
Organization Name:TAYLOR EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-951-0472
Mailing Address - Street 1:2155 HIGHWAY 18
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2773
Mailing Address - Country:US
Mailing Address - Phone:601-951-0472
Mailing Address - Fax:
Practice Address - Street 1:2155 HIGHWAY 18
Practice Address - Street 2:SUITE D
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2773
Practice Address - Country:US
Practice Address - Phone:601-951-0472
Practice Address - Fax:502-499-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G703561Medicare PIN
MS6483880001Medicare NSC