# PELTAN OPTICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558639922
- **Authorized official:** MRS. ANGELA IVENS PELTAN (PARTNER)
- **Authorized official phone:** 66254544600

## Contact information

- **Practice address:** 425B N DAVIS AVE, CLEVELAND, MS 38732-2351
- **Practice address phone:** (662) 545-4600
- **Practice address fax:** (662) 545-4595
- **Mailing address:** 425B N DAVIS AVE, CLEVELAND, MS 38732-2351
- **Mailing address phone:** (662) 545-4600
- **Mailing address fax:** (662) 545-4595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 20927 | MS | Yes |

## Other

- **Enumeration date:** 12/13/2011
- **Last updated:** 12/13/2011