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General NPI Number Information
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NPI Number | 1447551080
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Entity Type | Organization
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Legal Business Name | CATHERINE M. FORD, O.D., P.A.
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Dates
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Enumeration Date | 11/13/2010
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 1183 OLD DIXIE HWY SUITE A
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City | LAKE PARK
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State | FL
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Zip | 33403-2319
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Country | US
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Telephone | 561-848-8784
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Fax | 561-848-6213
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Provider Business Mailing Address
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Address Line | 1183 OLD DIXIE HWY SUITE A
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City | LAKE PARK
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State | FL
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Zip | 33403-2319
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Country | US
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Telephone | 561-848-8784
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Fax | 561-848-6213
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CATHERINE M. FORD
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Credential | O.D.
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Telephone | 561-848-8784
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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 | OPC002176
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License Number State | FL
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