Provider Demographics
NPI:1962658203
Name:SEE SIDE OPTICAL INC
Entity Type:Organization
Organization Name:SEE SIDE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:228-255-8585
Mailing Address - Street 1:5405 INDIAN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5405 INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3324
Practice Address - Country:US
Practice Address - Phone:228-255-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1962658203OtherNPI
MS00880009Medicaid
MS1902060643OtherNPI
MS410000086Medicare PIN
MST79185Medicare UPIN
MS1236180001Medicare NSC
MS1962658203OtherNPI