Provider Demographics
NPI:1427433200
Name:MISSISSIPPI EYECARE ASSOCIATES OF BYRAM, PLLC.
Entity type:Organization
Organization Name:MISSISSIPPI EYECARE ASSOCIATES OF BYRAM, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:BULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-366-9020
Mailing Address - Street 1:404 RIVERWIND DR
Mailing Address - Street 2:STE. B-1
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5900
Mailing Address - Country:US
Mailing Address - Phone:601-398-3000
Mailing Address - Fax:601-398-3002
Practice Address - Street 1:7118B S SIWELL RD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-8744
Practice Address - Country:US
Practice Address - Phone:601-398-3000
Practice Address - Fax:601-398-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS783152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS783OtherLICENSE