VICKSBURG OPTOMETRY LLC (NPI# 1326206186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326206186 |
| Entity Type | Organization |
| Organization Name | VICKSBURG OPTOMETRY LLC |
| Other Organization Name | MARIA L SHOOP DAVENPORT |
| Practice Address |
124 E Prairie Street Vicksburg MI 49097-1257 |
| Mailing Address |
124 E Prairie St Vicksburg MI 49097-1257 |
| Practice Telephone | 2696490103 |
| Practice Fax Number | 2696494762 |
| Mailing Telephone | 2696490103 |
| Mailing Fax Number | 2696494762 |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2016-02-17 |
| Authorized Official Name | DR. MARIA LYN SHOOP DAVENPORT (OWNER) |
| Authorized Official Telephone | 2696490103 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | 4901003648 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 944205383 | 05 |
| Other Name | Type Code |
|---|---|
| Maria L Shoop Davenport | Doing Business As Name - Organization |
| Street Address |
124 E PRAIRIE STREET |
| City | VICKSBURG |
| State | MI |
| Zip Code | 49097-1257 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912132168 | Jo Lynne Kirchhoff | Pharmacist | 110 S. Main Streets, Vicksburg, MI 49097 | 2009-05-18 |
| 1558429605 | Ellen Marie Tavarone | Dentist | 602 West Prairie St, Vicksburg, MI 49097 | 2006-12-04 |
| 1598875601 | Robert L Dornbos Dds PC | Dentist | 102 S Main, Vicksburg, MI 49097 | 2006-08-30 |
| 1982680468 | Freds Super Pharmacy Inc | Pharmacy | 121 W Prairie St, Vicksburg, MI 49097 | 2005-12-16 |
| 1477853422 | South County Home Health Providers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 115 N 3rd St, Vicksburg, MI 49097-1017 | 2010-10-25 |
| 1023214921 | Aaron C Ford | Dentist | 602 W Prairie St, Vicksburg, MI 49097-1178 | 2007-06-26 |
| 1154573392 | Family & Children Services, Inc. | Clinic/Center | 101 S Main St, Vicksburg, MI 49097-1210 | 2008-10-21 |
| 1144756610 | Pamela Hendershot | Pharmacist | 110 S Main St, Vicksburg, MI 49097-1211 | 2017-05-03 |
| 1598990525 | Kelly Ann Soekarmoen | Pharmacist | 110 S Main St, Vicksburg, MI 49097-1211 | 2009-05-19 |
| 1184670085 | Hill's Pharmacy of Vicksburg, Inc. | Pharmacy | 110 S Main St, Vicksburg, MI 49097-1211 | 2006-05-25 |
| Find all providers in zip 49097 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316113616 | Collins Eye Clinic Inc | Eyewear Supplier (Equipment, not the service) | 1206 Mission 66, Vicksburg, MS 39183-3137 | 2008-05-06 |
| 1417145624 | Professional Optical of Mississippi Inc | Eyewear Supplier (Equipment, not the service) | 1208 Mission 66, Vicksburg, MS 39183-3137 | 2007-10-12 |
| 1831307727 | Eyeline Optical of Vicksburg, Inc. | Eyewear Supplier (Equipment, not the service) | 2449 N Frontage Rd, Vicksburg, MS 39180-5177 | 2007-05-21 |
| 1881776698 | 20/20 Eye Works, Inc. | Eyewear Supplier (Equipment, not the service) | 3505 Pemberton Square Blvd, Suite 45, Vicksburg, MS 39180-5537 | 2006-10-20 |
| 1871602862 | The Vision Clinic of Vicksburg LLC | Eyewear Supplier (Equipment, not the service) | 1808 Mission 66, Vicksburg, MS 39180-3710 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245831783 | Anthony Curtis Mcconer Sr. | Eyewear Supplier (Equipment, not the service) | 457 Highland St Se, Grand Rapids, MI 49507-1204 | 2020-11-02 |
| 1164023610 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 3355 Henry St Ste H, Muskegon, MI 49441-4393 | 2020-11-02 |
| 1316545155 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 15523 Racho Blvd, Taylor, MI 48180-5213 | 2020-10-14 |
| 1043818859 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 6828 Rochester Rd, Troy, MI 48085-1291 | 2020-10-14 |
| 1851999692 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 45101 Towne Center Blvd, Chesterfield, MI 48047-6141 | 2020-10-14 |
| 1609488378 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 4816 Bay City Rd, Midland, MI 48642 | 2020-08-23 |
| 1831700061 | Optics Center | Eyewear Supplier (Equipment, not the service) | 6645 Schaefer Rd, Dearborn, MI 48126-1812 | 2020-08-11 |
| 1538784327 | Sassy Eyes Boutique, LLC | Eyewear Supplier (Equipment, not the service) | 28911 7 Mile Rd, Livonia, MI 48152-3503 | 2020-06-08 |
| 1508407982 | P-cor LLC | Eyewear Supplier (Equipment, not the service) | 1961 S. Telegraph Rd, Bloomfield Hills, MI 48302 | 2019-10-07 |
| 1972153666 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 15620 Hall Rd, Clinton Township, MI 48038-1036 | 2019-09-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.