Brookhaven Optical Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

BROOKHAVEN OPTICAL INC

Doing business as

Optical Outlet

Practice address

347 W Cherokee St
Brookhaven, MS 39601-3219

Phone

(601) 833-1958

Fax

(601) 833-3938

NPI assigned

Aug 22, 2005

Last updated

Aug 22, 2020By 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

Dr. Natlie Brown Herndon, M.S., PH.D.

Title

President

Phone

(601) 833-1958

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Optical Outlet Doing business as

Locations

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821080250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "347 W CHEROKEE ST",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396013219",
            "telephone_number": "601-833-1958",
            "fax_number": "601-833-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 W CHEROKEE ST",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396013219",
            "telephone_number": "601-833-1958",
            "fax_number": "601-833-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HERNDON",
        "authorized_official_first_name": "NATLIE",
        "authorized_official_middle_name": "BROWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-833-1958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.S., PH.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00089220",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optical Outlet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Brookhaven, MS
• Providers in Brookhaven, MS by specialty
• Eyewear Supplier in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.