Provider Demographics
NPI:1194731570
Name:GREEN EYE INSTITUTE PA
Entity type:Organization
Organization Name:GREEN EYE INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIPER
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-268-5144
Mailing Address - Street 1:2901 ARLINGTON LOOP
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7101
Mailing Address - Country:US
Mailing Address - Phone:601-268-5144
Mailing Address - Fax:601-268-5149
Practice Address - Street 1:2901 ARLINGTON LOOP
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7101
Practice Address - Country:US
Practice Address - Phone:601-268-5144
Practice Address - Fax:601-268-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B0259OtherMCARE RAILROAD
MS09011221Medicaid
MS0584440001Medicare NSC
MS09011221Medicaid