Provider Demographics
NPI:1275722498
Name:TROY S FORD OD PC
Entity Type:Organization
Organization Name:TROY S FORD OD PC
Other - Org Name:PAYSON EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-474-3556
Mailing Address - Street 1:411 S BEELINE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4892
Mailing Address - Country:US
Mailing Address - Phone:928-474-3556
Mailing Address - Fax:928-474-3161
Practice Address - Street 1:411 S BEELINE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4892
Practice Address - Country:US
Practice Address - Phone:928-474-3556
Practice Address - Fax:928-474-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOD790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101254Medicaid
AZZ70473Medicare UPIN
AZ4126560001Medicare NSC