Provider Demographics
NPI:1528261815
Name:PANDYA-LIPMAN EYE SPECIALIST, PLLC
Entity type:Organization
Organization Name:PANDYA-LIPMAN EYE SPECIALIST, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-349-3025
Mailing Address - Street 1:60 PHYSICIANS LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6122
Mailing Address - Country:US
Mailing Address - Phone:662-349-3025
Mailing Address - Fax:662-349-0708
Practice Address - Street 1:60 PHYSICIANS LN
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6122
Practice Address - Country:US
Practice Address - Phone:662-349-3025
Practice Address - Fax:662-349-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16645152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF82940Medicare UPIN