Provider Demographics
NPI:1780889923
Name:HATTIESBURG EYE CLINIC, PA
Entity type:Organization
Organization Name:HATTIESBURG EYE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-649-6507
Mailing Address - Street 1:1431 NORTH 10TH STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440
Mailing Address - Country:US
Mailing Address - Phone:601-649-6507
Mailing Address - Fax:
Practice Address - Street 1:1431 NORTH 10TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440
Practice Address - Country:US
Practice Address - Phone:601-649-6507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty