Organization
ROUTT EYE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE ADRIAN ROUTT O.D. (OPTOMETRIST)
(662) 289-4131
Entity
Organization
Contact information
Practice address
107 S NATCHEZ ST, KOSCIUSKO, MS 39090-3741
(662) 289-4131
(662) 289-5348
Mailing address
107 S NATCHEZ ST, KOSCIUSKO, MS 39090-3741
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
471
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087888
—
MS
Enumeration date
01/25/2008
Last updated
01/25/2008
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