Provider Demographics
NPI:1972590859
Name:BROOKS, JAMES E (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:BROOKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 BLUECUTT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1324
Mailing Address - Country:US
Mailing Address - Phone:662-327-2020
Mailing Address - Fax:662-327-6222
Practice Address - Street 1:3545 BLUECUTT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1324
Practice Address - Country:US
Practice Address - Phone:662-327-2020
Practice Address - Fax:662-327-6222
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087860Medicaid
MS410000347Medicare PIN
MS201590516OtherBLUECROSS BLUE SHIELD