Organization
GADDY EYE CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA E GADDY III MD (OWNER)
(228) 539-7762
Entity
Organization
Contact information
Practice address
10051 LORRAINE ROAD, SUITE A, GULFPORT, MS 39503-6001
(228) 539-7762
(228) 539-4953
Mailing address
10051 LORRAINE ROAD, SUITE A, GULFPORT, MS 39503
(228) 539-7762
(228) 539-4953
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
08343
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013310
—
MS
05
—
06303560
—
MS
01
—
08343
STATE LICENSE
MS
Enumeration date
04/06/2007
Last updated
06/16/2011
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