Provider Demographics
NPI:1336427822
Name:CAPITALEYES, INC
Entity Type:Organization
Organization Name:CAPITALEYES, INC
Other - Org Name:SOUTHERN EYECARE OF CLINTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-267-9351
Mailing Address - Street 1:929 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5246
Mailing Address - Country:US
Mailing Address - Phone:601-267-9351
Mailing Address - Fax:
Practice Address - Street 1:929 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5246
Practice Address - Country:US
Practice Address - Phone:601-267-9351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS605152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6616380001Medicare NSC