Provider Demographics
NPI:1295220101
Name:JTM ENTERPRISES, PLLC
Entity Type:Organization
Organization Name:JTM ENTERPRISES, PLLC
Other - Org Name:FORD VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINDALL
Authorized Official - Middle Name:DAWKINS
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-418-6727
Mailing Address - Street 1:103 LAUREL VALLEY CV
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-4382
Mailing Address - Country:US
Mailing Address - Phone:662-418-6727
Mailing Address - Fax:
Practice Address - Street 1:706 HIGHWAY 12 W STE F
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3573
Practice Address - Country:US
Practice Address - Phone:662-323-0571
Practice Address - Fax:662-323-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty