Provider Demographics
NPI:1154514578
Name:LENOIR, MARJORIE (OD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:LENOIR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:M
Other - Last Name:LENOIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:101 LEXINGTON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6969
Mailing Address - Country:US
Mailing Address - Phone:601-605-4423
Mailing Address - Fax:601-605-4437
Practice Address - Street 1:101 LEXINGTON DR
Practice Address - Street 2:SUITE C
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6969
Practice Address - Country:US
Practice Address - Phone:601-605-4423
Practice Address - Fax:601-605-4437
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04324730Medicaid
MS5121410042Medicare UPIN