Provider Demographics
NPI:1669721247
Name:STARKVILLE EYE CLINIC INC
Entity type:Organization
Organization Name:STARKVILLE EYE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 C STARK ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-320-6636
Mailing Address - Fax:662-320-3838
Practice Address - Street 1:1085 C STARK ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
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:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty