Provider Demographics
NPI:1528066644
Name:COLEMAN EYE CENTER, PLLC
Entity type:Organization
Organization Name:COLEMAN EYE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-455-4523
Mailing Address - Street 1:2005 HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2720
Mailing Address - Country:US
Mailing Address - Phone:662-455-4523
Mailing Address - Fax:662-455-3790
Practice Address - Street 1:2005 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2720
Practice Address - Country:US
Practice Address - Phone:662-455-4523
Practice Address - Fax:662-455-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4181580001OtherCIGNA GOVERNMENT SERVICES
MS09015746Medicaid
MS4181580001OtherCIGNA GOVERNMENT SERVICES
MS09015746Medicaid