NPIMap

Organization Active NPI

Ronald Mozingo, OD, LLC

  • Optometrist
  • Hattiesburg, MS
National Provider Identifier
1487915831
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
470 Issued in MS
Legal business name
RONALD MOZINGO, OD, LLC
Practice address
6096 U S Highway 98
Suite 1-a
Hattiesburg, MS 39402-8885
Phone
(601) 261-2467
Fax
(601) 296-6685
NPI assigned
Jun 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

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

Authorized official

Name
Ginger Keen
Title
Manager
Phone
(601) 261-2467

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 470 MS Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 826 MS

Addresses

Primary practice location

6096 U S Highway 98
Suite 1-a
Hattiesburg, MS 39402-8885

Mailing address

6096 U S Highway 98
Suite 1-a
Hattiesburg, MS 39402-8885
Phone (601) 261-2467

Other identifiers 2

IdentifierTypeStateIssuer
00087886MedicaidMS
04289596MedicaidMS

National Provider Directory

National Provider Directory

Locations

6096 U S Highway 98
Ste 1A
Hattiesburg, MS 39402
Phone (601) 261-2467

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338508800000",
    "number": "1487915831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6096 U S HIGHWAY 98",
            "address_2": "SUITE 1-A",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028885",
            "telephone_number": "601-261-2467",
            "fax_number": "601-296-6685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6096 U S HIGHWAY 98",
            "address_2": "SUITE 1-A",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028885",
            "telephone_number": "601-261-2467",
            "fax_number": "601-296-6685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD MOZINGO, OD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-01",
        "last_updated": "2012-06-01",
        "status": "A",
        "authorized_official_last_name": "KEEN",
        "authorized_official_first_name": "GINGER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-261-2467"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MS",
            "license": "470",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MS",
            "license": "826",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00087886",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04289596",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; 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.