Provider Demographics
NPI:1841885159
Name:OPTICDOK INC.
Entity type:Organization
Organization Name:OPTICDOK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:O'KELLEY HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:228-875-3318
Mailing Address - Street 1:2510 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3117
Mailing Address - Country:US
Mailing Address - Phone:228-875-3318
Mailing Address - Fax:228-875-3398
Practice Address - Street 1:2105 OLD SPANISH TRAIL
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553
Practice Address - Country:US
Practice Address - Phone:228-205-7761
Practice Address - Fax:228-875-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty