Precision Optical Dispensary, Inc.

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

PRECISION OPTICAL DISPENSARY, INC.

Practice address

1490 West Government Street Suite 8
Precision Optical Dispensary, Inc.
Brandon, MS 39042

Phone

(601) 825-1992

Fax

(601) 825-1091

NPI assigned

Apr 4, 2007

Last updated

Oct 15, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Glyn Wayne Harris

Title

President

Phone

(601) 825-1992

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1104948793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 WEST GOVERNMENT STREET SUITE 8",
            "address_2": "PRECISION OPTICAL DISPENSARY, INC.",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "39042",
            "telephone_number": "601-825-1992",
            "fax_number": "601-825-1091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 WEST GOVERNMENT STREET SUITE 8",
            "address_2": "PRECISION OPTICAL DISPENSARY, INC.",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "39042",
            "telephone_number": "601-825-1992",
            "fax_number": "601-825-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRECISION OPTICAL DISPENSARY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "GLYN",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-825-1992",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "MS",
            "license": "10192",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00880113",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.