Individual
DR. KREGG S BLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D
Contact information
Practice address
5300 HIGHWAY 18 W, JACKSON, MS 39209-9411
(601) 922-3233
Mailing address
5300 HIGHWAY 18 W, JACKSON, MS 39209-9411
(601) 922-3233
(601) 922-9225
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
598
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00880136
—
MS
01
—
16054
SPECTERA
MS
01
—
251027
NVA
MS
01
—
26696
AVESIS
MS
01
—
42775
DAVIS
MS
01
—
MS0598
EYEMED/COLE
MS
Enumeration date
09/22/2006
Last updated
12/21/2018
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