Provider Demographics
NPI:1750350070
Name:HARRINGTON, BETHANY G (OD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:G
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-0521
Mailing Address - Country:US
Mailing Address - Phone:601-795-0137
Mailing Address - Fax:601-795-0148
Practice Address - Street 1:1716 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-4287
Practice Address - Country:US
Practice Address - Phone:601-795-0137
Practice Address - Fax:601-795-0148
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880221Medicaid
MSC02306OtherMEDICARE GROUP
MS05785365Medicaid
MSU92635640789939OtherUNITED HEALTH CARE
MS1962800011OtherPOPLARVILLE EYE CLINIC NPI
MSC02306OtherMEDICARE GROUP
MS410000267Medicare ID - Type UnspecifiedMEDICARE