Provider Demographics
NPI:1174749345
Name:EYE CARE CENTER
Entity type:Organization
Organization Name:EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-947-3553
Mailing Address - Street 1:852 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-5726
Mailing Address - Country:US
Mailing Address - Phone:601-947-3553
Mailing Address - Fax:601-947-3933
Practice Address - Street 1:852 WINTER ST
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-5726
Practice Address - Country:US
Practice Address - Phone:601-947-3553
Practice Address - Fax:601-947-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS410045258OtherRAILROAD MEDICARE
MS09015561Medicaid
MS=========OtherBCBS