CUSTOM OPTICAL OF FONDREN LLC; NPI #1467622605

Contact Information

CUSTOM OPTICAL OF FONDREN LLC

661 DULING AVE
JACKSON, MS 39216-4008

Phone: 601-362-6675
Fax: 601-362-5767
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Eyewear Supplier	332H00000X	87	All Other Suppliers

Indicates primary specialty

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NPI Profile & details for CUSTOM OPTICAL OF FONDREN LLC

NPI Number	`1467622605`
LBN Legal business name	CUSTOM OPTICAL OF FONDREN LLC
Authorized official	PATRICIA HAMMONS - (OWNER/OPTICIAN)
Entity	Organization
Organization subpart ¹	No
Enumeration date	03/04/2008
Last updated	04/29/2022 - About 4 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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CUSTOM OPTICAL OF FONDREN LLC

Contact Information

Specialty

Eyewear Supplier

NPI Profile & details for CUSTOM OPTICAL OF FONDREN LLC

Reviews for CUSTOM OPTICAL OF FONDREN LLC