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General NPI Number Information
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NPI Number | 1912179565
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Entity Type | Organization
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Legal Business Name | DR. JEFFERY B FORD & ASSOC.
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 1501 AL HIGHWAY 14 E
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City | SELMA
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State | AL
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Zip | 36703-3201
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Country | US
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Telephone | 334-230-9694
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Fax |
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Provider Business Mailing Address
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Address Line | 1963 WALNUT ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1532
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Country | US
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Telephone | 334-230-9694
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFERY B FORD
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Credential | O.D.
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Telephone | 334-230-9694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | S910 TA465
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License Number State | AL
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