Provider Demographics
NPI:1841363629
Name:MOZINGO, RONALD C (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:MOZINGO
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 1:6096 US HWY 98
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-261-2467
Mailing Address - Fax:601-296-6685
Practice Address - Street 1:6096 US HWY 98
Practice Address - Street 2:SUITE 1A
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-261-2467
Practice Address - Fax:601-296-6685
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00037724OtherPALMETTO GBA RR MEDICARE
MS00087886Medicaid
MS00087886Medicaid