Provider Demographics
NPI:1710201454
Name:LAURA E MCCALOP DO LLC
Entity Type:Organization
Organization Name:LAURA E MCCALOP DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIGGINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-981-1550
Mailing Address - Street 1:3000 OLD CANTON RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4200
Mailing Address - Country:US
Mailing Address - Phone:601-681-1550
Mailing Address - Fax:601-981-0804
Practice Address - Street 1:3000 OLD CANTON RD
Practice Address - Street 2:SUITE 305
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4200
Practice Address - Country:US
Practice Address - Phone:601-681-1550
Practice Address - Fax:601-981-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty