Individual
LORI L BLACKMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
908 SIXTH AVE, PICAYUNE, MS 39466-3802
(601) 798-4182
(601) 798-4770
Mailing address
908 SIXTH AVE, PICAYUNE, MS 39466-3802
(601) 798-4182
(601) 798-4770
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
559
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087010
—
MS
01
—
1922067016
PICAYUNE EYE CLINIC NPI
MS
01
—
2230045
UNITED HEALTH CARE
MS
01
—
410012249
MEDICARE RAILROAD RETIREM
MS
01
—
C02306
MEDICARE GROUP
MS
01
—
DA2690
MEDICARE RR GROUP
MS
Enumeration date
03/15/2006
Last updated
03/01/2010
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