Individual
MICHAEL BURKS MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3929 N GLOSTER ST, TUPELO, MS 38804-0915
(662) 840-4624
Mailing address
1020 N GLOSTER ST # 333, TUPELO, MS 38804-1202
(662) 871-4167
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
983
MS
Other
Enumeration date
07/24/2018
Last updated
07/24/2018
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