Provider Demographics
NPI:1710256367
Name:BRET FORD EYE CARE PC
Entity Type:Organization
Organization Name:BRET FORD EYE CARE PC
Other - Org Name:FORD EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-315-3673
Mailing Address - Street 1:714 HILL COUNTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6066
Mailing Address - Country:US
Mailing Address - Phone:830-315-3673
Mailing Address - Fax:830-315-3939
Practice Address - Street 1:714 HILL COUNTRY DRIVE
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6066
Practice Address - Country:US
Practice Address - Phone:830-315-3673
Practice Address - Fax:830-315-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5121T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU57402Medicare UPIN