Provider Demographics
NPI:1770221301
Name:OPHTHALMOLOGY CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-985-9120
Mailing Address - Street 1:501 BAPTIST DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-2031
Mailing Address - Country:US
Mailing Address - Phone:601-985-9120
Mailing Address - Fax:601-985-9122
Practice Address - Street 1:501 BAPTIST DR STE 220
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2031
Practice Address - Country:US
Practice Address - Phone:601-985-9120
Practice Address - Fax:601-985-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Single Specialty