Provider Demographics
NPI:1134522576
Name:IRVING EYE CARE LLC
Entity type:Organization
Organization Name:IRVING EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:QUATRISA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-957-6078
Mailing Address - Street 1:1200 E COUNTY LINE RD
Mailing Address - Street 2:STE 166
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1949
Mailing Address - Country:US
Mailing Address - Phone:601-957-6078
Mailing Address - Fax:601-957-6924
Practice Address - Street 1:1200 E COUNTY LINE RD
Practice Address - Street 2:STE 166
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1949
Practice Address - Country:US
Practice Address - Phone:601-957-6078
Practice Address - Fax:601-957-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty