MEDICARE: DR. DAVID MARSHALL FORD O.D.

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	620	MS

General Provider Information

NPI Number	:	1598809048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MARSHALL FORD O.D.

Provider Business Mailing Address
First Line	:	PO BOX 4195
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39535-4195
Country	:	US
Telephone Number	:	228-424-6264
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 BEACH BLVD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4606
Country	:	US
Telephone Number	:	228-388-8495
Fax Number	:

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

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	07/08/2007

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