Individual
CHARLES RICHARD FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4742 BLACK SWAN DRIVE, SHAWNEE, KS 66216
(913) 268-0265
(913) 768-8210
Mailing address
4742 BLACK SWAN DRIVE, SHAWNEE, KS 66216
(913) 268-0265
(913) 768-8210
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
04-13088
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-13088
KANSAS STATE BOARD OF HEALING ARTS
KS
Enumeration date
06/18/2009
Last updated
06/18/2009
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