Provider Demographics
NPI:1710260310
Name:ENVISION EYE CARE, INC
Entity Type:Organization
Organization Name:ENVISION EYE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYATTA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-987-3937
Mailing Address - Street 1:1100 JR LYNCH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39203-3311
Mailing Address - Country:US
Mailing Address - Phone:601-487-6812
Mailing Address - Fax:601-487-6818
Practice Address - Street 1:1100 JR LYNCH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39203-3311
Practice Address - Country:US
Practice Address - Phone:601-487-6812
Practice Address - Fax:601-487-6818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVISION EYE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS825261QH0100X
MS658261QH0100X
MS844261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service