Provider Demographics
NPI:1962679043
Name:HATTIESBURG EYE CLINIC PA
Entity Type:Organization
Organization Name:HATTIESBURG EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STONEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-268-5910
Mailing Address - Street 1:100 HOSPITAL DR W
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1334
Mailing Address - Country:US
Mailing Address - Phone:601-268-5910
Mailing Address - Fax:601-264-0659
Practice Address - Street 1:1223 HWY 42
Practice Address - Street 2:STE 140
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465
Practice Address - Country:US
Practice Address - Phone:601-445-0226
Practice Address - Fax:601-450-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty