Individual
DR. CHARLES P TILLMAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3126 E ROANE AVE, EUPORA, MS 39744-2638
(662) 258-2020
(662) 258-2030
Mailing address
PO BOX 225, 3126 E ROANE AVE, 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
—
0087039
—
MS
05
—
1772968
—
LA
Enumeration date
09/20/2006
Last updated
05/27/2008
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