Provider Demographics
NPI:1972517506
Name:EVANS, FRANK JR
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-0139
Mailing Address - Country:US
Mailing Address - Phone:662-628-5139
Mailing Address - Fax:662-628-1974
Practice Address - Street 1:400 NORTH MAIN STEET
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-0139
Practice Address - Country:US
Practice Address - Phone:662-628-5139
Practice Address - Fax:662-628-1974
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS448152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087795Medicaid
MS560945772Medicare ID - Type UnspecifiedMEDICARE ID#
MS00087795Medicaid
MS3751310001Medicare NSC