Provider Demographics
NPI:1912179565
Name:DR. JEFFERY B FORD & ASSOC.
Entity Type:Organization
Organization Name:DR. JEFFERY B FORD & ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:B
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:
Practice Address - Street 1:1501 AL HIGHWAY 14 E
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-3201
Practice Address - Country:US
Practice Address - Phone:334-230-9694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS910 TA465152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529929840Medicaid