Provider Demographics
NPI:1902967847
Name:BILL NOBLES & SON COUNTRY OPTICAL, INC.
Entity Type:Organization
Organization Name:BILL NOBLES & SON COUNTRY OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-268-0671
Mailing Address - Street 1:16 OFFICE PARK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6021
Mailing Address - Country:US
Mailing Address - Phone:601-268-0671
Mailing Address - Fax:601-264-4762
Practice Address - Street 1:16 OFFICE PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6021
Practice Address - Country:US
Practice Address - Phone:601-268-0671
Practice Address - Fax:601-264-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087020Medicaid
MS00087020Medicaid