Provider Demographics
NPI:1558372052
Name:FORD, TONYA R (OD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:R
Last Name:FORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 FALLS AVE E
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-736-2020
Mailing Address - Fax:208-734-8393
Practice Address - Street 1:1411 FALLS AVE E
Practice Address - Street 2:SUITE 105
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3455
Practice Address - Country:US
Practice Address - Phone:208-736-2020
Practice Address - Fax:208-734-8393
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1874152W00000X
IDODP-100216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist