Organization
MENDENHALL OPTOMETRIC EYE CLINIC, P.A.
Active
Other names
Mendenhall Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL WILLARD CLARK O.D. (PRESIDENT)
(601) 847-1232
Entity
Organization
Contact information
Practice address
1021 EAST ST, MENDENHALL, MS 39114-3107
(601) 847-1232
(601) 847-1376
Mailing address
P. O. BOX 577, MENDENHALL, MS 39114-3107
(601) 847-1232
(601) 847-1376
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
423
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087015
—
MS
01
—
C03245
GROUP SUPPLIER CODE
MS
Enumeration date
03/27/2007
Last updated
04/20/2008
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