Provider Demographics
NPI:1942285564
Name:EYE CLINIC OF MERIDIAN PLLC
Entity Type:Organization
Organization Name:EYE CLINIC OF MERIDIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARASCALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-485-2368
Mailing Address - Street 1:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-1551
Mailing Address - Country:US
Mailing Address - Phone:601-485-2368
Mailing Address - Fax:601-693-2174
Practice Address - Street 1:1301 20TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4121
Practice Address - Country:US
Practice Address - Phone:601-485-2368
Practice Address - Fax:601-693-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550437Medicaid
AL009943235Medicaid
AL180041975OtherDR MASON-RR MEDICARE
MS00880212Medicaid
AL051550436Medicaid
MS00116589Medicaid
MS00116642Medicaid
AL051554358OtherDR JOHNSON-RR MEDICARE
AL180041976OtherDR MARASCALCO-RR MEDICARE
AL051550436Medicaid
ALI424Medicare PIN
AL051554358Medicare ID - Type UnspecifiedERIC J. JOHNSON II OD
MS180000242Medicare ID - Type UnspecifiedJ. LAWRENCE MASON JR MD
MS00116642Medicaid
G36508Medicare UPIN
ALI424Medicare ID - Type UnspecifiedGROUP PROVIDER ID
AL009943235Medicaid
MS00116589Medicaid
MS00880212Medicaid
AL051550436Medicare ID - Type UnspecifiedDON E. MARASCALCO, MD
AL180041976OtherDR MARASCALCO-RR MEDICARE
MS180000241Medicare ID - Type UnspecifiedDON E MARASCALCO MD