Organization
MUDDY WATER ENTERPRISES, LLC
Active
Other names
Ford Vision Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REAGAN LEE FORD II O.D. (MANAGER)
(662) 822-2020
Entity
Organization
Contact information
Practice address
706 HIGHWAY 12 W STE F, STARKVILLE, MS 39759-3573
(662) 323-0571
(662) 323-6365
Mailing address
706 HIGHWAY 12 W STE F, STARKVILLE, MS 39759-3573
(662) 323-0571
(662) 323-6365
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
651
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00880151
—
MS
Enumeration date
06/05/2012
Last updated
06/05/2012
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