Provider Demographics
NPI:1043410202
Name:HARRELL FAMILY EYE CLINIC, INC.
Entity type:Organization
Organization Name:HARRELL FAMILY EYE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROLD
Authorized Official - Middle Name:ARNARD
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-684-2220
Mailing Address - Street 1:902 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3826
Mailing Address - Country:US
Mailing Address - Phone:601-684-2220
Mailing Address - Fax:601-684-8417
Practice Address - Street 1:902 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3826
Practice Address - Country:US
Practice Address - Phone:601-684-2220
Practice Address - Fax:601-684-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty