Provider Demographics
NPI:1972678134
Name:EYE ASSOCIATES OF THE SOUTH PLLC
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF THE SOUTH PLLC
Other - Org Name:EYE ASSOCIATES OF THE SOUTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-396-5185
Mailing Address - Street 1:1720A MEDICAL PARK DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2129
Mailing Address - Country:US
Mailing Address - Phone:228-396-5185
Mailing Address - Fax:228-396-5186
Practice Address - Street 1:1720A MEDICAL PARK DR
Practice Address - Street 2:SUITE 330
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2129
Practice Address - Country:US
Practice Address - Phone:228-396-5185
Practice Address - Fax:228-396-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09692207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014031Medicaid
MS6135820001Medicare NSC
MSC04593Medicare PIN
MS09014031Medicaid