Provider Demographics
NPI:1891003422
Name:STARKVILLE EYE CLINIC
Entity Type:Organization
Organization Name:STARKVILLE EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYLAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-320-6636
Mailing Address - Street 1:1085 STARK RD
Mailing Address - Street 2:SUITE C
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
Practice Address - Street 2:SUITE C
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:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS767332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier