Provider Demographics
NPI:1013256411
Name:MISSISSIPPI EYECARE ASSOCIATES OF PEARL, PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI EYECARE ASSOCIATES OF PEARL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-366-9020
Mailing Address - Street 1:404 RIVERWIND DR
Mailing Address - Street 2:STE B1
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5900
Mailing Address - Country:US
Mailing Address - Phone:601-366-9020
Mailing Address - Fax:601-321-3979
Practice Address - Street 1:404 RIVERWIND DR
Practice Address - Street 2:STE B1
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5900
Practice Address - Country:US
Practice Address - Phone:601-366-9020
Practice Address - Fax:601-321-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS783152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty