NPIMap

Organization Active NPI

Ms Eye Care PA

Doing business as Mississippi Eye Care Louisville

  • Optometrist
  • Louisville, MS
National Provider Identifier
1386656924
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MS EYE CARE PA
Doing business as
Mississippi Eye Care Louisville
Practice address
14994 W Main St
Louisville, MS 39339-2616
Phone
(662) 773-3494
Fax
(662) 773-7883
NPI assigned
Aug 12, 2006
Last updated
May 24, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MS EYE CARE PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2022

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

Authorized official

Name
Tammy Womble
Title
Credentialing
Phone
(624) 446-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

14994 W Main St
Louisville, MS 39339-2616

Mailing address

14994 W Main St
Louisville, MS 39339-2616
Phone (662) 773-3494

Other identifiers 1

IdentifierTypeStateIssuer
05208871MedicaidMS

Other names 1

  • MISSISSIPPI EYE CARE LOUISVILLE Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2050290Mississippi Eye Care Louisville14994 W Main St, Louisville, MS 39339Certificate of waiverNov 25, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Louisville Eye Care14994 W Main St, Louisville, MS 39339-2616(662) 773-3494 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Nov 15, 2023

National Provider Directory

National Provider Directory
Tax ID family
Ms Eye Care PA12 organizations share this tax ID, including this one
Part of
Ms Eye Care PA

Other organizations with this tax ID 11

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

Locations

411 Chester St
Ackerman, MS 39735
Phone (662) 285-9148

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1386656924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14994 W MAIN ST",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393392616",
            "telephone_number": "662-773-3494",
            "fax_number": "662-773-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14994 W MAIN ST",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393392616",
            "telephone_number": "662-773-3494",
            "fax_number": "662-773-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MS EYE CARE PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MS EYE CARE PA",
        "enumeration_date": "2006-08-12",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "WOMBLE",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "624-446-9000"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05208871",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MISSISSIPPI EYE CARE LOUISVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.