Provider Demographics
NPI:1558089979
Name:SOUTHERN EYE CARE OF VICKSBURG PA
Entity Type:Organization
Organization Name:SOUTHERN EYE CARE OF VICKSBURG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:YALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-267-9351
Mailing Address - Street 1:1206 MISSION 66
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-3137
Mailing Address - Country:US
Mailing Address - Phone:601-638-2081
Mailing Address - Fax:
Practice Address - Street 1:1206 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-3137
Practice Address - Country:US
Practice Address - Phone:601-638-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty