Provider Demographics
NPI:1043716665
Name:SHIPP & WOOTEN EYE CENTER PLLC
Entity type:Organization
Organization Name:SHIPP & WOOTEN EYE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSOE
Authorized Official - Phone:662-286-2020
Mailing Address - Street 1:306 BRADLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7047
Mailing Address - Country:US
Mailing Address - Phone:662-286-6068
Mailing Address - Fax:662-286-0188
Practice Address - Street 1:306 BRADLEY RD STE B
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7047
Practice Address - Country:US
Practice Address - Phone:662-286-6068
Practice Address - Fax:662-286-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19893207W00000X
MS06029207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty