MEDICARE: LAYNE MARI FORD OD

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	152W00000X	Optometrist	9192	TX

General Provider Information

NPI Number	:	1720517477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAYNE MARI FORD OD

Provider Business Mailing Address
First Line	:	714 HILL COUNTRY DR
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-6066
Country	:	US
Telephone Number	:	830-315-3673
Fax Number	:	830-315-3939

Provider Business Practice Location Address
First Line	:	714 HILL COUNTRY DR
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-6066
Country	:	US
Telephone Number	:	308-315-3673
Fax Number	:	830-315-3939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	06/08/2020

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