Provider Demographics
NPI:1639591613
Name:PELTAN EYE CENTERS OF MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:PELTAN EYE CENTERS OF MISSISSIPPI, LLC
Other - Org Name:PELTAN EYE & LASER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PELTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-461-6077
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-1269
Mailing Address - Country:US
Mailing Address - Phone:662-545-4600
Mailing Address - Fax:
Practice Address - Street 1:425B N DAVIS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2351
Practice Address - Country:US
Practice Address - Phone:662-545-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty