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General NPI Number Information
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NPI Number | 1871964361
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Entity Type | Individual
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Provider Name | MARILU FORD O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1515 BUSINESS CENTER DR STE 4
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4401
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Country | US
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Telephone | 904-278-1760
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Fax | 904-278-1730
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Provider Business Mailing Address
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Address Line | 13193 CHRISTINE MARIE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32225-2692
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Country | US
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Telephone | 407-394-4294
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5139
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License Number State | FL
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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 | 15397
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License Number State | CA
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