Organization
COLUMBUS OPTICAL DISPENSARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JAROD LEE (OWNER)
(662) 328-5781
Entity
Organization
Contact information
Practice address
1928 5TH ST N, COLUMBUS, MS 39705
(662) 328-5781
(662) 328-7281
Mailing address
1928 5TH ST N, COLUMBUS, MS 39705-2206
(662) 328-5781
(662) 328-7281
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00089020
—
MS
Enumeration date
07/22/2006
Last updated
06/21/2018
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