Provider Demographics
NPI:1902826696
Name:FORD, REAGAN LEE II (OD)
Entity Type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:LEE
Last Name:FORD
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:522 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5306
Mailing Address - Country:US
Mailing Address - Phone:662-327-7271
Mailing Address - Fax:888-611-8850
Practice Address - Street 1:522 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5306
Practice Address - Country:US
Practice Address - Phone:662-327-7271
Practice Address - Fax:888-611-8850
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880151Medicaid
MSU83278Medicare UPIN