Provider Demographics
NPI:1174677330
Name:FORD, CRAIG A (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:FORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-0166
Mailing Address - Country:US
Mailing Address - Phone:765-348-2020
Mailing Address - Fax:765-348-2503
Practice Address - Street 1:315 HUGGINS DR
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-8999
Practice Address - Country:US
Practice Address - Phone:765-348-2020
Practice Address - Fax:765-348-2503
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002085A152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410028184OtherRRMC
IN100059580Medicaid
INT34519Medicare UPIN
IN1046420001Medicare NSC
IN410028184OtherRRMC