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General NPI Number Information
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NPI Number | 1275722498
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Entity Type | Organization
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Legal Business Name | TROY S FORD OD PC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 411 S BEELINE HWY SUITE A
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City | PAYSON
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State | AZ
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Zip | 85541-4892
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Country | US
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Telephone | 928-474-3556
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Fax | 928-474-3161
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Provider Business Mailing Address
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Address Line | 411 S BEELINE HWY SUITE A
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City | PAYSON
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State | AZ
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Zip | 85541-4892
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Country | US
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Telephone | 928-474-3556
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Fax | 928-474-3161
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TROY S FORD
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Credential | OD
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Telephone | 928-474-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD790
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License Number State | AZ
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