Provider Demographics
NPI:1730294315
Name:NASSAR & JONES EYE CLINIC PA
Entity Type:Organization
Organization Name:NASSAR & JONES EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-362-2897
Mailing Address - Street 1:764 LAKELAND DR SUITE 405
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4618
Mailing Address - Country:US
Mailing Address - Phone:601-362-2897
Mailing Address - Fax:601-362-3441
Practice Address - Street 1:764 LAKELAND DR SUITE 405
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4618
Practice Address - Country:US
Practice Address - Phone:601-362-2897
Practice Address - Fax:601-362-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6426207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B30981Medicare UPIN