Mississippi Band of Choctaw Indians

NPI #1114240421 in Choctaw, Mississippi

Provider Information

NPI Number: 1114240421
Entity Type: Organization
Organization Name: Mississippi Band of Choctaw Indians
Subpart: Yes (part of a larger organization)
Parent Organization: MISSISSIPPI BAND OF CHOCTAW INDIANS
Primary Specialty: Optometrist
Enumeration Date: Mar 2, 2010
Last Updated: Jun 15, 2012

Practice Location

Address: 210 HOSPITAL CIR
City: Choctaw
State: Mississippi
ZIP Code: 39350-6781
Phone: (601) 656-2211

Authorized Official

Name: MRS. PHYLLIS J ANDERSON
Title: TRIBAL CHIEF
Phone: (601) 389-6342

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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