NPIMap

Organization Active NPI

Muddy Water Enterprises, LLC

  • Optometrist
  • Starkville, MS
National Provider Identifier
1346501442
Registry record updated Jun 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
651 Issued in MS
Legal business name
MUDDY WATER ENTERPRISES, LLC
Doing business as
Ford Vision Clinic
Practice address
706 Highway 12 W Ste F
Starkville, MS 39759-3573
Phone
(662) 323-0571
Fax
(662) 323-6365
NPI assigned
Jun 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Reagan Lee Ford II, O.D.NPI 1902826696
Title
Manager
Phone
(662) 822-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 651 MS Primary

Addresses

Primary practice location

706 Highway 12 W Ste F
Starkville, MS 39759-3573

Mailing address

706 Highway 12 W Ste F
Starkville, MS 39759-3573
Phone (662) 323-0571

Other identifiers 1

IdentifierTypeStateIssuer
00880151MedicaidMS

Other names 1

  • Ford Vision Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

706 Highway 12 W
#F
Starkville, MS 39759
Phone (662) 323-0571

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338854400000",
    "number": "1346501442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 HIGHWAY 12 W STE F",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397593573",
            "telephone_number": "662-323-0571",
            "fax_number": "662-323-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 HIGHWAY 12 W STE F",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397593573",
            "telephone_number": "662-323-0571",
            "fax_number": "662-323-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUDDY WATER ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-05",
        "last_updated": "2012-06-05",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "REAGAN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "662-822-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MS",
            "license": "651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00880151",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ford Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Starkville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.