Organization
WILBURN LORD JR
Active
Other names
Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUTH ANDERSON (PRACTICE MANAGER)
(662) 332-0163
Entity
Organization
Contact information
Practice address
239 S WASHINGTON AVE, GREENVILLE, MS 38701-4234
(662) 332-0163
(662) 378-3394
Mailing address
239 S WASHINGTON AVE, GREENVILLE, MS 38701-4234
(662) 332-0163
(662) 378-3394
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087850
—
MS
Enumeration date
04/21/2008
Last updated
06/23/2008
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