Provider Demographics
NPI:1043048572
Name:DELOACH, JASMINE SHALISA (OD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:SHALISA
Last Name:DELOACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9028 HWY 45 SOUTH ALTERNATE
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:MS
Mailing Address - Zip Code:39743
Mailing Address - Country:US
Mailing Address - Phone:662-328-5225
Mailing Address - Fax:
Practice Address - Street 1:1823 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2203
Practice Address - Country:US
Practice Address - Phone:662-328-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist