Organization
LARRY E. FORTH O.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY E FORTH (OPTOMETRIST)
(912) 384-1840
Entity
Organization
Contact information
Practice address
200 DOCTORS DRIVE, SUITE 105, DOUGLAS, GA 31533
(912) 384-1840
(912) 384-5976
Mailing address
POST OFFICE BOX 2740, DOUGLAS, GA 31534
(912) 384-1840
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
842T
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000151819C
—
GA
01
—
117755
EYEMED VISION CARE
GA
01
—
410027578
RAIL ROAD MEDICARE
GA
Enumeration date
03/26/2007
Last updated
06/17/2008
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