MEDICARE: MUM-FORD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	S2395	OH

General Provider Information

NPI Number	:	1447650650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUM-FORD INC

Provider Business Mailing Address
First Line	:	6129 SAINT CLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-1627
Country	:	US
Telephone Number	:	216-541-3937
Fax Number	:	216-391-3930

Provider Business Practice Location Address
First Line	:	6129 SAINT CLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-1627
Country	:	US
Telephone Number	:	216-541-3937
Fax Number	:	216-391-3930

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALICIA FORD
Credential	:
Telephone Number	:	216-541-3937

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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Directions to “MUM-FORD INC ” Practice Location

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