Provider Demographics
NPI:1750804704
Name:ZAMPELLA, JUSTIN COREY (OD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:COREY
Last Name:ZAMPELLA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-9370
Mailing Address - Country:US
Mailing Address - Phone:662-983-2323
Mailing Address - Fax:
Practice Address - Street 1:208 W CALHOUN ST
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-9370
Practice Address - Country:US
Practice Address - Phone:662-983-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist