Organization
OPTOMETRIC CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN A WILLIAMS OD (PARTNER)
(601) 545-2020
Entity
Organization
Contact information
Practice address
600 W PINE ST, HATTIESBURG, MS 39401-3834
(601) 545-2020
(601) 583-0120
Mailing address
600 W PINE ST, HATTIESBURG, MS 39401-3834
(601) 545-2020
(601) 583-0120
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
508
MS
152W00000X
Optometrist
550
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087064
—
MS
05
—
00880007
—
MS
01
—
410012873
RR MEDICARE
MS
01
—
540017775
RRMEDICARE
MS
Enumeration date
11/15/2006
Last updated
12/13/2010
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