Organization
20-20 EYECARE OF GRENADA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER T WALLS OD (OWNER)
(662) 226-7010
Entity
Organization
Contact information
Practice address
600 OLD HICKORY RD, GRENADA, MS 38901-2727
(662) 226-7010
(662) 226-7027
Mailing address
600 OLD HICKORY RD, GRENADA, MS 38901-2727
(662) 226-7010
(662) 226-7027
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00880101
—
MS
Enumeration date
01/11/2012
Last updated
04/26/2012
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