Provider Demographics
NPI:1720194830
Name:FORD, SCOTT B (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:B
Last Name:FORD
Suffix:
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 1:651 TIMBER HILL RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4013
Mailing Address - Country:US
Mailing Address - Phone:847-772-1904
Mailing Address - Fax:847-647-8952
Practice Address - Street 1:5630 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4001
Practice Address - Country:US
Practice Address - Phone:847-647-8970
Practice Address - Fax:847-647-8952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU27462Medicare UPIN