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General NPI Number Information
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NPI Number | 1598843476
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Entity Type | Individual
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Provider Name | JEFFERY BRIAN FORD SR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 1845 CHERRY ST
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City | MONTGOMERY
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State | AL
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Zip | 36107-2613
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Country | US
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Telephone | 334-420-5001
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Fax | 334-420-0160
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Provider Business Mailing Address
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Address Line | 1845 CHERRY ST
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City | MONTGOMERY
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State | AL
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Zip | 36107-2613
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Country | US
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Telephone | 334-420-5001
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Fax | 334-420-0160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | S-910
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | S-910
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-910
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License Number State | AL
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