Provider Demographics
NPI:1013086479
Name:FORD ROTTMAN, ASHLEY RAE (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:FORD ROTTMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 BOOKCLIFF AVE
Mailing Address - Street 2:#102
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8133
Mailing Address - Country:US
Mailing Address - Phone:970-242-8727
Mailing Address - Fax:970-242-8774
Practice Address - Street 1:1190 BOOKCLIFF AVE
Practice Address - Street 2:#102
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8133
Practice Address - Country:US
Practice Address - Phone:970-242-8727
Practice Address - Fax:970-242-8774
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist