Bly, Kregg S

Bly, Kregg S is an sole proprietor health care provider with primary practice located at 5300 Highway 18 W , Jackson MS 39209-9411. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bly, Kregg S can be contacted via phone (601) 922-3233.

Contact Information

Primary practice address
5300 Highway 18 W Jackson MS 39209-9411
Phone: (601) 922-3233
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 598 Mississippi

Profile Details

NPI number 1679672729
LBN Legal business name Bly, Kregg S
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 22nd, 2006
Last updated Dec 21st, 2018 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679672729 NPPES
Mississippi Other 251027 NVA
Mississippi Other 42775 NVA
Mississippi Other 16054 NVA
Mississippi Other MS0598 NVA
Mississippi MEDICAID 00880136 NVA
Mississippi Other 26696 NVA

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