Provider Demographics
NPI:1609116581
Name:HORN LAKE EYECARE PLLC
Entity Type:Organization
Organization Name:HORN LAKE EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-893-3300
Mailing Address - Street 1:6947 CRUMPLER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1922
Mailing Address - Country:US
Mailing Address - Phone:662-893-3300
Mailing Address - Fax:662-893-3301
Practice Address - Street 1:2085 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637
Practice Address - Country:US
Practice Address - Phone:662-893-3300
Practice Address - Fax:662-893-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS606152W00000X
MS647152W00000X
MS681152W00000X
MS857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty