Provider Demographics
NPI:1740423599
Name:OXFORD FAMILY VISION CLINIC, INC
Entity Type:Organization
Organization Name:OXFORD FAMILY VISION CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-234-0400
Mailing Address - Street 1:1110 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2844
Mailing Address - Country:US
Mailing Address - Phone:662-234-0400
Mailing Address - Fax:662-234-0403
Practice Address - Street 1:1110 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2844
Practice Address - Country:US
Practice Address - Phone:662-234-0400
Practice Address - Fax:662-234-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880034Medicaid
MS00880034Medicaid
MS410000034Medicare PIN