Provider Demographics
NPI:1831216365
Name:HATTIESBURG EYE CLINIC, PA
Entity type:Organization
Organization Name:HATTIESBURG EYE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-268-5910
Mailing Address - Street 1:100 HOSPITAL DR W
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1334
Mailing Address - Country:US
Mailing Address - Phone:601-268-5910
Mailing Address - Fax:
Practice Address - Street 1:1010 HIGHWAY 13 N
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2047
Practice Address - Country:US
Practice Address - Phone:601-736-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty