Individual
DEBRA GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5405 INDIAN HILL BLVD, DIAMONDHEAD, MS 39525-3324
(228) 255-8585
Mailing address
5405 INDIAN HILL BLVD, DIAMONDHEAD, MS 39525-3324
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
541
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0880024
—
MS
Enumeration date
02/28/2007
Last updated
07/08/2007
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