MEDICARE: BRET FORD EYE CARE PC

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	5121T	TX

General Provider Information

NPI Number	:	1710256367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRET FORD EYE CARE PC

Provider Business Mailing Address
First Line	:	714 HILL COUNTRY DRIVE
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-6066
Country	:	US
Telephone Number	:	830-315-3673
Fax Number	:	830-315-3939

Provider Business Practice Location Address
First Line	:	714 HILL COUNTRY DRIVE
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-6066
Country	:	US
Telephone Number	:	830-315-3673
Fax Number	:	830-315-3939

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	BRET FORD
Credential	:
Telephone Number	:	830-315-3673

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	01/27/2012

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