Provider Demographics
NPI:1841561412
Name:FORD, MATTHEW D (LDO)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:FORD
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-5118
Mailing Address - Country:US
Mailing Address - Phone:330-343-1215
Mailing Address - Fax:
Practice Address - Street 1:130 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3829
Practice Address - Country:US
Practice Address - Phone:330-343-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062829Medicaid
6689000001Medicare NSC