Provider Demographics
NPI:1598843476
Name:FORD, JEFFERY BRIAN SR (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:BRIAN
Last Name:FORD
Suffix:SR
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 1:1963 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1532
Mailing Address - Country:US
Mailing Address - Phone:334-230-9694
Mailing Address - Fax:334-230-9697
Practice Address - Street 1:1963 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1532
Practice Address - Country:US
Practice Address - Phone:334-230-9694
Practice Address - Fax:334-230-9697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-910152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics