NPIMap

Organization Active NPI

Barnes Crossing Vision Center P. a.

  • Optometrist
  • Tupelo, MS
National Provider Identifier
1407825037
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
487 Issued in MS
Legal business name
BARNES CROSSING VISION CENTER P. A.
Practice address
3929 N Gloster St
Tupelo, MS 38804-0915
Phone
(662) 840-4624
NPI assigned
Mar 16, 2006
Last updated
Nov 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Mr. Mike L McCullough, M.S.
Title
Office Manager
Phone
(662) 243-2600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 487 MS Primary
Corneal and Contact Management Optometrist 152WC0802X TPA 94061 MS

Addresses

Primary practice location

3929 N Gloster St
Tupelo, MS 38804-0915

Mailing address

1028 Fawn Dr
Tupelo, MS 38804-1924
Phone (662) 840-4624

Other identifiers 1

IdentifierTypeStateIssuer
03888791MedicaidMS

Other names 1

  • Tupelo Vision Center Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1407825037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 FAWN DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388041924",
            "telephone_number": "662-840-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 N GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388040915",
            "telephone_number": "662-840-4624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARNES CROSSING VISION CENTER P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-243-2600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "487",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MS",
            "license": "TPA 94061",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03888791",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tupelo Vision Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.