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Individual

DR. JARED ACKER GRANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
5219 HIGHWAY 51 N, SENATOBIA, MS 38668-1719
(662) 612-6016
(662) 612-6031
Mailing address
5219 HIGHWAY 51 N, SENATOBIA, MS 38668-1719
(662) 612-6016
(662) 612-6031

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618003092
VA
152W00000X
Optometrist
3847-35
WI
152W00000X
Optometrist
Primary
923
MS
152W00000X
Optometrist
R-295-TA-C49
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04774359
MS
Enumeration date
07/15/2015
Last updated
03/06/2023
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