Organization
EYE CLINIC OF EUPORA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES TILLMAN JR. O.D. (OPTOMETRIST)
(662) 258-2020
Entity
Organization
Contact information
Practice address
3126 E ROANE AVE, EUPORA, MS 39744-2638
(662) 258-2020
(662) 258-2030
Mailing address
PO BOX 225, EUPORA, MS 39744-0225
(662) 258-2020
(662) 258-2030
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
519
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014730
—
MS
Enumeration date
03/07/2007
Last updated
11/12/2010
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