Provider Demographics
NPI:1346334554
Name:MS EYE CARE, PA
Entity type:Organization
Organization Name:MS EYE CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:A
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-656-3296
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350
Mailing Address - Country:US
Mailing Address - Phone:662-446-9000
Mailing Address - Fax:662-779-4030
Practice Address - Street 1:1054 AIRPARK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3368
Practice Address - Country:US
Practice Address - Phone:601-656-3296
Practice Address - Fax:601-656-8164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MS EYE CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09011905Medicaid
MS0408550001Medicare NSC
MSC00329Medicare PIN