Organization
PICAYUNE EYE CLINIC
Active
Other names
Poplarville Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LORI L BLACKMER OD (OWNER)
(601) 798-4182
Entity
Organization
Contact information
Practice address
1249 S MAIN ST, POPLARVILLE, MS 39470-3313
(601) 795-0137
(601) 798-4770
Mailing address
908 SIXTH AVE, PICAYUNE, MS 39466
(601) 798-4182
(601) 798-4770
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
559
MS
152W00000X
Optometrist
584
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00087010
LORI L. BLACKMER, O.D. MEDICAID
MS
05
—
00880022
—
MS
05
—
00880221
—
MS
01
—
0661580001
PALMETTO GBA DMERC
MS
01
—
09014613
MS MEDICAID GROUP PROV#
MS
01
—
1346215274
MARC A. HAUTOT- NPI
MS
01
—
1750350070
BETHANY HARRINGTON, O.D. NPI
MS
01
—
1760451595
LORI L. BLACKMER, . O.D. NPI
MS
01
—
22-30045
UNITED HEALTH CARE
MS
01
—
263673909
LORI. L BLACKMER- BLUE CROSS BLUE SHIELD
MS
01
—
410000162
MEDICARE-DR MARC A. HAUTOT
MS
01
—
410000163
MEDICARE
MS
01
—
410000267
MEDICARE
MS
01
—
410012249
MEDICARE RAIL ROAD
MS
01
—
425297177
BLUE CROSS BLUE SHIELD
MS
01
—
435044954D
BLUE CROSS BLUE SHIELD-DR MARC A. HAUTOT
MS
01
—
MS0685
EYE MED
MS
01
—
P00043499
MEDICARE RAILROAD RETIREMENT
MS
01
—
T95634
LORI L. BLACKMER, O.D. UPIN
MS
01
—
U92635
UPIN
MS
Enumeration date
04/29/2008
Last updated
07/16/2008
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