Provider Demographics
NPI:1396808259
Name:HUMBER, JAMES FLOWERS IV (OD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FLOWERS
Last Name:HUMBER
Suffix:IV
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 FRIARS POINT RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-9111
Mailing Address - Country:US
Mailing Address - Phone:662-627-2020
Mailing Address - Fax:662-627-7063
Practice Address - Street 1:636 FRIARS POINT RD
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-9111
Practice Address - Country:US
Practice Address - Phone:662-627-2020
Practice Address - Fax:662-627-7063
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880128Medicaid
410000188Medicare ID - Type Unspecified
MS00880128Medicaid