Bodford, Mallory Phillips
Bodford, Mallory Phillips is an individual health care provider with primary practice located at 6947 Crumpler Blvd , Olive Branch MS 38654-1922. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Bodford, Mallory Phillips can be contacted via phone (662) 893-3300.Contact Information
Primary practice address
6947 Crumpler Blvd
Olive Branch MS 38654-1922
Phone: (662) 893-3300
Fax: (662) 893-3301
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 8517T | Texas |
Profile Details
| NPI number | 1932518032 |
|---|---|
| LBN Legal business name | Bodford, Mallory Phillips |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 4th, 2014 |
| Last updated | Feb 17th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932518032 | NPPES |
| Mississippi | MEDICAID | 05005854 | |
| Mississippi | Other | 966P-Y |
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