Individual
DR. SHANE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3005 FOUNTAIN DRIVE, CONWAY, AR 72034-3684
(501) 329-9851
(501) 329-9854
Mailing address
3005 FOUNTAIN DRIVE, CONWAY, AR 72034-3684
(501) 329-9851
(501) 329-9854
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2505
AR
152WC0802X
Corneal and Contact Management Optometrist
2505
AR
152WL0500X
Low Vision Rehabilitation Optometrist
2505
AR
152WP0200X
Pediatric Optometrist
2505
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140746722
—
AR
Enumeration date
03/21/2006
Last updated
10/18/2007
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