Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1100X | Ophthalmic | ||
N | 156FX1201X | Optometric Assistant |
NPI | 1174729727 |
---|---|
Provider Name | Mr. Thomas A. Ford |
First Address | Sugar Land, TX 77498-7169 |
Second Address | Houston, TX 77079-1611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 21/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138975 | ABO CERTIFICATION (01) |