Provider Demographics
NPI:1639857055
Name:MATHIS, MORGAN LEANN (OD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEANN
Last Name:MATHIS
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 1:3201 GAINES RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8422
Mailing Address - Country:US
Mailing Address - Phone:662-286-8860
Mailing Address - Fax:662-286-3079
Practice Address - Street 1:3201 GAINES RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-8422
Practice Address - Country:US
Practice Address - Phone:662-286-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS1073P-Y152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program