Organization
GTREC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REAGAN L FORD SR. O.D. (OWNER)
(662) 323-0571
Entity
Organization
Contact information
Practice address
522 ALABAMA ST, COLUMBUS, MS 39702-5306
(662) 327-7271
(662) 327-7271
Mailing address
522 ALABAMA ST, COLUMBUS, MS 39702-5306
(623) 277-2716
(662) 327-7271
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
466
MS
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087840
—
MS
Enumeration date
12/02/2010
Last updated
02/06/2024
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