NPIMap

Organization Active NPI

Holly Springs Eyecare PLLC

Doing business as Magnolia Eye Group

  • Optometrist
  • Holly Springs, MS
National Provider Identifier
1356430987
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
HOLLY SPRINGS EYECARE PLLC
Doing business as
Magnolia Eye Group
Practice address
130 W Van Dorn Ave
Holly Springs, MS 38635-2902
Phone
(662) 252-3323
NPI assigned
Oct 12, 2006
Last updated
Jun 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Authorized official

Name
Dr. Stephen P Edwards, ODNPI 1013015585
Title
Managing Director
Phone
(662) 473-2181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

130 W Van Dorn Ave
Holly Springs, MS 38635-2902

Mailing address

130 W Van Dorn Ave
Holly Springs, MS 38635-2902
Phone (662) 252-3323

Other identifiers 1

IdentifierTypeStateIssuer
05784776MedicaidMS

Other names 1

  • Magnolia Eye Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070103000181 MS Part B Supplier - Clinic/Group Practice 2668472374 Receives reassigned benefits from 6 practitioners
4 other NPIs on this enrollment
Practice locations: Calhoun City, MS; Hernando, MS; Holly Springs, MS; Senatobia, MS; Water Valley, MS
O20100930043172 MS DME Supplier - Physician - Optometrist 2668472374 Practice locations: Holly Springs, MS

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Holly Springs Eyecare PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

130 W Van Dorn Ave
Holly Springs, MS 38635
Phone (662) 252-3323

3045 Highway 51 S
Senatobia, MS 38668
Phone (662) 562-5500

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1356430987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 W VAN DORN AVE",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352902",
            "telephone_number": "662-252-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W VAN DORN AVE",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352902",
            "telephone_number": "662-252-3323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLY SPRINGS EYECARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "662-473-2181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05784776",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Eye Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holly Springs, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.