Provider Demographics
NPI:1629225354
Name:HARRELL FAMILY EYE CLINIC NO. 2 INC.
Entity Type:Organization
Organization Name:HARRELL FAMILY EYE CLINIC NO. 2 INC.
Other - Org Name:KIMBERLY HARRELL, O.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-684-3688
Mailing Address - Street 1:PO BOX 1393
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-1393
Mailing Address - Country:US
Mailing Address - Phone:601-684-3688
Mailing Address - Fax:
Practice Address - Street 1:1608 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2049
Practice Address - Country:US
Practice Address - Phone:601-684-3685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty