Provider Demographics
NPI:1457794695
Name:PRESLEY EYE CARE, PLLC
Entity Type:Organization
Organization Name:PRESLEY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-791-0454
Mailing Address - Street 1:2885 MCCULLOUGH BLVD.
Mailing Address - Street 2:SUITE F
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-9022
Mailing Address - Country:US
Mailing Address - Phone:662-791-0454
Mailing Address - Fax:662-791-0464
Practice Address - Street 1:2885 MCCULLOUGH BLVD.
Practice Address - Street 2:SUITE F
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-9022
Practice Address - Country:US
Practice Address - Phone:662-791-0454
Practice Address - Fax:662-791-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04339363Medicaid
MS410000328Medicare PIN
MSV03545Medicare UPIN