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General NPI Number Information
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NPI Number | 1760598957
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Entity Type | Organization
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Legal Business Name | FORD FAMILY EYE CARE, P.C.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 CARROLLTON VILLA RICA HWY
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City | VILLA RICA
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State | GA
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Zip | 30180-4969
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Country | US
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Telephone | 770-459-8733
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Fax | 770-459-8673
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Provider Business Mailing Address
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Address Line | 5154 THOUSAND OAKS CV NW
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City | KENNESAW
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State | GA
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Zip | 30152-2861
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Country | US
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Telephone | 770-528-6607
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Fax | 770-459-8673
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD R FORD
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Credential | O.D.
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Telephone | 770-528-6607
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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 | 1874
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1869
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License Number State | GA
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