Provider Demographics
NPI:1649423971
Name:DR. JEFFERY B. FORD AND ASSOC.,LLC
Entity Type:Organization
Organization Name:DR. JEFFERY B. FORD AND ASSOC.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-230-9694
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS 910 TA 465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU73209Medicare UPIN