Organization
KERN OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
M DENNIS BROOKS (OPERATING OWNER)
(228) 864-4397
Entity
Organization
Contact information
Practice address
15277 CREOSOTE RD, GULFPORT, MS 39503-4233
(228) 864-4397
Mailing address
15277 CREOSOTE RD, GULFPORT, MS 39503-4233
(228) 864-4397
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00089822
—
MS
Enumeration date
10/02/2006
Last updated
08/22/2020
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