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Individual

MILES DAVID ASHLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1808 MISSION 66, VICKSBURG, MS 39180-3710
(601) 636-6364
(601) 636-1162
Mailing address
1808 MISSION 66, VICKSBURG, MS 39180-3710
(601) 636-6364
(601) 636-1162

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
878
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09001077
MS
01
878
MS STATE LICENSE
MS
Enumeration date
07/23/2013
Last updated
04/03/2014
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