MEDICARE: DR. CATHERINE M FORD OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OP002176	FL

General Provider Information

NPI Number	:	1073520441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE M FORD OD

Provider Business Mailing Address
First Line	:	1183 OLD DIXIE HIGHWAY
Second Line	:	SUITE A
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2343
Country	:	US
Telephone Number	:	561-848-8784
Fax Number	:	561-848-6213

Provider Business Practice Location Address
First Line	:	1183 OLD DIXIE HIGHWAY
Second Line	:	SUITE A
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2343
Country	:	US
Telephone Number	:	561-848-8784
Fax Number	:	561-848-6213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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