Larry E Forth O D P C

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT000842 Issued in GA

Legal business name

LARRY E FORTH O D P C

Doing business as

Colony Optical

Practice address

708 S Grant St
Suite #18
Fitzgerald, GA 31750

Phone

(229) 423-5556

Fax

(229) 423-5179

NPI assigned

Mar 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Larry E Forth

Title

Optometrist

Phone

(229) 423-5556

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Colony Optical Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224460800000",
    "number": "1306966791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 S GRANT ST SUITE #18",
            "address_2": "PO BOX 5209",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "31750",
            "telephone_number": "229-423-5556",
            "fax_number": "229-423-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 S GRANT ST",
            "address_2": "SUITE #18",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "31750",
            "telephone_number": "229-423-5556",
            "fax_number": "229-423-5179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY E FORTH O D P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2008-10-20",
        "status": "A",
        "authorized_official_last_name": "FORTH",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "229-423-5556",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT000842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000151819C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED VISION CARE",
            "identifier": "117755",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colony Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edd C Jones III, MD
• Johnna Lee Kendrick, SLP-CF
• Kids Health
• Chelsie Nicole King
• Sandra Larkin, CCC-SLP
• Samantha Leyse
• LF SNF LLC (Life Care Center)
• James Edwin Luckie Jr., D.O.
• Lisa Marie Luckie, FNP-C
• Robert A Ludwick, MD

• Optometrist in Fitzgerald, GA
• Providers in Fitzgerald, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.