Provider Demographics
NPI:1881744282
Name:RIDGELAND EYECARE CENTER
Entity type:Organization
Organization Name:RIDGELAND EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:REGINALD
Authorized Official - Last Name:DAMPIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:601-957-8444
Mailing Address - Street 1:PO BOX 2790
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-2790
Mailing Address - Country:US
Mailing Address - Phone:601-957-8444
Mailing Address - Fax:601-956-7147
Practice Address - Street 1:8 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4113
Practice Address - Country:US
Practice Address - Phone:601-957-8444
Practice Address - Fax:601-956-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9015841Medicaid
410000252Medicare ID - Type Unspecified