Ford, Shane
Ford, Shane is an individual health care provider with primary practice located at 3005 Fountain Drive , Conway AR 72034-3684. He recently has 4 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Low Vision Rehabilitation, Eye and Vision Services Providers / Pediatrics. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Ford, Shane can be contacted via phone (501) 329-9851.Contact Information
Primary practice address
3005 Fountain Drive
Conway AR 72034-3684
Phone: (501) 329-9851
Fax: (501) 329-9854
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2505 | Arkansas |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 2505 | Arkansas |
| Eye and Vision Services Providers / Low Vision Rehabilitation | 152WL0500X | 2505 | Arkansas |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | 2505 | Arkansas |
Profile Details
| NPI number | 1497714075 |
|---|---|
| LBN Legal business name | Ford, Shane |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 21st, 2006 |
| Last updated | Oct 18th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497714075 | NPPES |
| Arkansas | MEDICAID | 140746722 |
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