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Organization

RAYNER OPTICAL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS M TANN III MD (OWNER)
(662) 234-6551
Entity
Organization

Contact information

Practice address
1308 BELK BLVD, OXFORD, MS 38655-5302
(662) 234-0173
Mailing address
1308 BELK BLVD, OXFORD, MS 38655-5302

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0898070001
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00880056
MS
01
425720541B
BLUE CROSS BLUE SHIELD
MS
Enumeration date
08/31/2006
Last updated
02/11/2008
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