Provider Demographics
NPI:1962412429
Name:MISSISSIPPI VISION CORRECTION CENTER, PLLC
Entity type:Organization
Organization Name:MISSISSIPPI VISION CORRECTION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-969-1430
Mailing Address - Street 1:1053 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9595
Mailing Address - Country:US
Mailing Address - Phone:601-969-1430
Mailing Address - Fax:601-709-2117
Practice Address - Street 1:1053 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9595
Practice Address - Country:US
Practice Address - Phone:601-969-1430
Practice Address - Fax:601-709-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9015463Medicaid
MS9015463Medicaid