Provider Demographics
NPI:1760598957
Name:FORD FAMILY EYE CARE, P.C.
Entity Type:Organization
Organization Name:FORD FAMILY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-528-6607
Mailing Address - Street 1:5154 THOUSAND OAKS CV NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2861
Mailing Address - Country:US
Mailing Address - Phone:770-528-6607
Mailing Address - Fax:770-459-8673
Practice Address - Street 1:600 CARROLLTON VILLA RICA HWY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4969
Practice Address - Country:US
Practice Address - Phone:770-459-8733
Practice Address - Fax:770-459-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1869152W00000X
GA1874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty