Organization
LARRY E FORTH O D P C
Active
Other names
Colony Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY E FORTH (OPTOMETRIST)
(229) 423-5556
Entity
Organization
Contact information
Practice address
708 S GRANT ST, SUITE #18, FITZGERALD, GA 31750
(229) 423-5556
(229) 423-5179
Mailing address
708 S GRANT ST SUITE #18, PO BOX 5209, FITZGERALD, GA 31750
(229) 423-5556
(229) 423-5179
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT000842
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000151819C
—
GA
01
—
117755
EYEMED VISION CARE
GA
Enumeration date
03/30/2007
Last updated
10/20/2008
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