Provider Demographics
NPI:1467633990
Name:RRTI HOLDING LLC
Entity Type:Organization
Organization Name:RRTI HOLDING LLC
Other - Org Name:EYEDEAL OPTICAL STARKVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:662-332-3325
Mailing Address - Street 1:1085 STARK RD STE C
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3682
Mailing Address - Country:US
Mailing Address - Phone:662-320-6636
Mailing Address - Fax:662-320-3838
Practice Address - Street 1:1085 STARK RD STE C
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3682
Practice Address - Country:US
Practice Address - Phone:662-320-6636
Practice Address - Fax:662-320-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty