Provider Demographics
NPI:1134210123
Name:GREGORY, JOSEPH E (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:GREGORY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1410 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2916
Mailing Address - Country:US
Mailing Address - Phone:228-875-2088
Mailing Address - Fax:228-875-2092
Practice Address - Street 1:5405 INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3324
Practice Address - Country:US
Practice Address - Phone:228-255-8585
Practice Address - Fax:228-875-2092
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1902060643OtherNPI
MS410027652OtherRAILROAD MEDICARE PTAN
MS1962658203OtherNPI
MS00880009Medicaid
MS1902060643OtherNPI
MS1236180001Medicare NSC
MS410027652OtherRAILROAD MEDICARE PTAN
MS410000086Medicare Oscar/Certification
MS1236180002Medicare NSC