Provider Demographics
NPI:1912112780
Name:TAYLOR, ANNA POPE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:POPE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LOFLIN
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:315 CROSSGATES BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2615
Mailing Address - Country:US
Mailing Address - Phone:601-951-0472
Mailing Address - Fax:
Practice Address - Street 1:2155 HIGHWAY 18 STE D
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2774
Practice Address - Country:US
Practice Address - Phone:601-706-4752
Practice Address - Fax:601-510-9394
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I416150Medicare PIN
MS302I413560Medicare PIN