Provider Demographics
NPI:1922283852
Name:CONTACT CARE OPTICAL
Entity Type:Organization
Organization Name:CONTACT CARE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:601-922-8282
Mailing Address - Street 1:4531 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-4806
Mailing Address - Country:US
Mailing Address - Phone:601-922-8282
Mailing Address - Fax:601-922-8052
Practice Address - Street 1:4531 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-4806
Practice Address - Country:US
Practice Address - Phone:601-922-8282
Practice Address - Fax:601-922-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880219Medicaid