Individual
DR. FRED H MOTHERSHED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3353 N GLOSTER ST, TUPELO, MS 38804-9735
(662) 844-3555
(662) 840-5614
Mailing address
3353 N GLOSTER ST, TUPELO, MS 38804-9735
(662) 844-3555
(662) 840-5614
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
451
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0880222
—
MS
Enumeration date
05/24/2005
Last updated
07/26/2011
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