Vivian Marie Fountain O.D.

NPI 1790877413 - Optometrist - 152W00000X

NPI Details
NPI 1790877413
Gender Female
Enumeration Date 09/29/2006
Last Updated 12/09/2009
Entity Type Individual
Active Over 10 years ago
Practice Location
910 23RD AVE
DEARMAN OPTICAL CENTER
MERIDIAN MS, 39301, US
Phone (601) 482-2020
Fax (601) 693-1847
Business Location
PO BOX 1590
910 23RD AVE DEARMAN OPTICAL CENTER
MERIDIAN MS, 39301, US
Phone (601) 482-2020
Fax (601) 693-1847
Toxanomy
Taxonomy Code 152W00000X
License State Mississippi
License Number MS 638
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According to our database, Ms. Vivian Marie Fountain O.D. NPI is 1790877413, taxonomy code is 152W00000X and license number is MS 638, license state is located at Mississippi. Vivian Marie Fountain O.D. physically located at 910 23rd Ave, Meridian MS, 39301. NPI Number Vivian Marie Fountain O.D. has the Individual type.

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1790877413 NPI number is provided on an as is basis without warranty of any kind. 1790877413 is maintained by the National Plan & Provider Enumeration System. The contents of Vivian Marie Fountain O.D. are for informational purposes only.