Provider Demographics
NPI:1639280274
Name:BROOKS EYE CENTER INC
Entity type:Organization
Organization Name:BROOKS EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-327-2020
Mailing Address - Street 1:3545 BLUECUTT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1324
Mailing Address - Country:US
Mailing Address - Phone:662-327-2020
Mailing Address - Fax:662-327-6222
Practice Address - Street 1:3545 BLUECUTT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1324
Practice Address - Country:US
Practice Address - Phone:662-327-2020
Practice Address - Fax:662-327-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087860Medicaid
MS=========OtherBLUE CROSS BLUE SHIELD
MS=========Medicare UPIN
MS6234130001Medicare NSC
MSC03393Medicare PIN