Organization
PICAYUNE EYE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI L BLACKMER O.D. (OWNER)
(601) 798-4182
Entity
Organization
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
—
0661580001
PALMETTOGBA
—
01
—
2230045
UNITED HEALTH CARE
MS
01
—
263673909
BLUE CROSS BLUE SHIELD
MS
01
—
410012249
MEDICARE RAILROAD RETIREM
MS
01
—
C02306
MEDICARE GROUP
MS
01
—
DA2690
MEDICARE/RR GROUP
MS
Enumeration date
03/20/2006
Last updated
03/18/2010
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