Provider Demographics
NPI:1427253160
Name:EYECARE EXPRESS, LLC
Entity type:Organization
Organization Name:EYECARE EXPRESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-553-0527
Mailing Address - Street 1:1733 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4514
Mailing Address - Country:US
Mailing Address - Phone:601-553-0527
Mailing Address - Fax:601-553-1355
Practice Address - Street 1:1733 2ND ST S
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4514
Practice Address - Country:US
Practice Address - Phone:601-553-0527
Practice Address - Fax:601-553-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS704152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06506733Medicaid