Provider Demographics
NPI:1801065636
Name:AMORY EYE CLINIC
Entity type:Organization
Organization Name:AMORY EYE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-256-9711
Mailing Address - Street 1:607 EARL FRYE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5503
Mailing Address - Country:US
Mailing Address - Phone:662-256-9711
Mailing Address - Fax:662-256-1047
Practice Address - Street 1:607 EARL FRYE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5503
Practice Address - Country:US
Practice Address - Phone:662-256-9711
Practice Address - Fax:662-256-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0393260001Medicare NSC