Provider Demographics
NPI:1922008952
Name:FORD, MICHAEL EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
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 1:1975 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8388
Mailing Address - Country:US
Mailing Address - Phone:276-647-3937
Mailing Address - Fax:276-647-3990
Practice Address - Street 1:1975 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8388
Practice Address - Country:US
Practice Address - Phone:276-647-3937
Practice Address - Fax:276-647-3990
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V477F50Medicare ID - Type Unspecified