Provider Demographics
NPI:1124060744
Name:RANKIN EYE PROFESSIONALS
Entity type:Organization
Organization Name:RANKIN EYE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMILY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-455-1155
Mailing Address - Street 1:120 HOLT COLLIER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-4408
Mailing Address - Country:US
Mailing Address - Phone:601-455-1155
Mailing Address - Fax:800-948-4615
Practice Address - Street 1:314 SGT PRENTISS DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4224
Practice Address - Country:US
Practice Address - Phone:601-455-1155
Practice Address - Fax:800-948-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03739257Medicaid
MSC03516Medicare PIN