Provider Demographics
NPI:1710790316
Name:SHANE E. FORD OD PA
Entity type:Organization
Organization Name:SHANE E. FORD OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-329-9851
Mailing Address - Street 1:3005 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3684
Mailing Address - Country:US
Mailing Address - Phone:501-329-9851
Mailing Address - Fax:501-329-9854
Practice Address - Street 1:2526 HWY. 64 S.
Practice Address - Street 2:SUITE 104
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-2500
Practice Address - Fax:501-745-7772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANE E. FORD, OD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty