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DR. SHANE FORD O.D.

Eye and Vision Services Providers Optometrist

Provider NPI: 1497714075

Provider Information:
DR. SHANE  FORD O.D.
Gender: M
Not Sole Proprietor

Practice Location:
3005 FOUNTAIN DRIVE  CONWAY, AR 72034-3684 US
Tel: 501-329-9851  Fax: 501-329-9854

Business Mailing Address:
3005 FOUNTAIN DRIVE  CONWAY, AR 72034-3684 US
Tel: 501-329-9851  Fax: 501-329-9854

NPI Information:
NPI: 1497714075
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
AR2505
N152WC0802XEye and Vision Services Providers
Optometrist
AR2505
N152WL0500XEye and Vision Services Providers
Optometrist
AR2505
N152WP0200XEye and Vision Services Providers
Optometrist
AR2505

Other Provider Identifiers:

IssuerNumberStateType
140746722AR05



American Medical Association 2012 taxonomy code information

Code: 152W00000X

Type:

Classification:



Definition:



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