Provider Demographics
NPI:1528249497
Name:OBRIEN EYE CARE
Entity type:Organization
Organization Name:OBRIEN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-647-8707
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-0354
Mailing Address - Country:US
Mailing Address - Phone:662-647-8707
Mailing Address - Fax:662-647-8706
Practice Address - Street 1:426 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2413
Practice Address - Country:US
Practice Address - Phone:662-647-8707
Practice Address - Fax:662-647-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087700Medicaid
MST21280Medicare UPIN
MS00087700Medicaid