Organization
BROOKHAVEN OPTICAL INC
Active
Other names
Optical Outlet
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATLIE BROWN HERNDON M.S., PH.D. (PRESIDENT)
(601) 833-1958
Entity
Organization
Contact information
Practice address
347 W CHEROKEE ST, BROOKHAVEN, MS 39601-3219
(601) 833-1958
(601) 833-3938
Mailing address
347 W CHEROKEE ST, BROOKHAVEN, MS 39601-3219
(601) 833-1958
(601) 833-3938
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00089220
—
MS
Enumeration date
08/22/2005
Last updated
08/22/2020
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