Provider Demographics
NPI:1770786188
Name:CARTHAGE EYE CLINIC PA
Entity type:Organization
Organization Name:CARTHAGE EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-267-9351
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-0911
Mailing Address - Country:US
Mailing Address - Phone:601-267-9351
Mailing Address - Fax:601-267-9004
Practice Address - Street 1:201 HWY 16 EAST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051
Practice Address - Country:US
Practice Address - Phone:601-267-9351
Practice Address - Fax:601-267-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2011-01-03
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
MS5196240001OtherDMERC
MS00880054Medicaid
MS586608111BOtherBCBS
MS02157371Medicaid
MS02157371Medicaid
MS586608111BOtherBCBS