Provider Demographics
NPI:1285070524
Name:INSIGHT EYECARE, INC.
Entity type:Organization
Organization Name:INSIGHT EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:HELLUMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-561-1234
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-0557
Mailing Address - Country:US
Mailing Address - Phone:662-561-1234
Mailing Address - Fax:662-729-4510
Practice Address - Street 1:205 HOUSE CARLSON DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-7643
Practice Address - Country:US
Practice Address - Phone:662-561-1234
Practice Address - Fax:662-729-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03734792Medicaid