Healthcare Provider Details

I. General information

NPI: 1598843476
Provider Name (Legal Business Name): JEFFERY BRIAN FORD SR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CHERRY ST
MONTGOMERY AL
36107-2613
US

IV. Provider business mailing address

1845 CHERRY ST
MONTGOMERY AL
36107-2613
US

V. Phone/Fax

Practice location:
  • Phone: 334-420-5001
  • Fax: 334-420-0160
Mailing address:
  • Phone: 334-420-5001
  • Fax: 334-420-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberS-910
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberS-910
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-910
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: