Organization
CUSTOM OPTICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY LYNN CORNETT (MANAGER)
(601) 485-2747
Entity
Organization
Contact information
Practice address
1301 20TH AVE, MERIDIAN, MS 39301-4121
(601) 485-2747
(601) 693-2174
Mailing address
1301 20TH AVE, MERIDIAN, MS 39301-4121
(601) 485-2747
(601) 693-2174
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00880086
—
MS
Enumeration date
12/05/2006
Last updated
04/20/2008
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