Provider Demographics
NPI:1326877457
Name:ROUNSAVALL, COLLIN QUINN (OD)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:QUINN
Last Name:ROUNSAVALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7832
Mailing Address - Country:US
Mailing Address - Phone:662-378-2085
Mailing Address - Fax:
Practice Address - Street 1:1607 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7832
Practice Address - Country:US
Practice Address - Phone:662-378-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist