Provider Demographics
NPI:1629751326
Name:FORD, RHONDA (DO)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9204
Mailing Address - Country:US
Mailing Address - Phone:804-957-6424
Mailing Address - Fax:804-957-6449
Practice Address - Street 1:3500 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9204
Practice Address - Country:US
Practice Address - Phone:804-957-6424
Practice Address - Fax:804-957-6449
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002202156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician