Individual
DR. BETHANY ANN SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
16 SOUTH 16TH ST, BAY SPRINGS, MS 39422
(601) 764-2120
(601) 764-3410
Mailing address
PO BOX 728, BAY SPRINGS, MS 39422-0728
(601) 764-2120
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
13338
CA
152W00000X
Optometrist
Primary
831
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13338
CALIFORNIA BOARD OF OPTOM
CA
01
—
831
OPTOMETRY LICENSE
MS
Enumeration date
07/30/2007
Last updated
01/12/2011
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