Provider Demographics
NPI:1679682835
Name:COLLINS, C. CHRIS (O D)
Entity Type:Individual
Prefix:DR
First Name:C. CHRIS
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:601-638-2171
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:601-638-2171
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS522152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087003Medicaid
MS4940200001Medicare NSC
MS6129070001Medicare NSC
MSTN074EMedicare UPIN
MS00087003Medicaid