Larry E. Forth O.D.P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

842T Issued in GA

Legal business name

LARRY E. FORTH O.D.P.C.

Practice address

200 Doctors Drive
Suite 105
Douglas, GA 31533

Phone

(912) 384-1840

Fax

(912) 384-5976

NPI assigned

Mar 26, 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

(912) 384-1840

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1316065725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POST OFFICE BOX 2740",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31534",
            "telephone_number": "912-384-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DOCTORS DRIVE",
            "address_2": "SUITE 105",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-384-1840",
            "fax_number": "912-384-5976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY E. FORTH O.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2008-06-17",
        "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": "912-384-1840",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "842T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED VISION CARE",
            "identifier": "117755",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000151819C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410027578",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hadequa Noor Khan, MD
• Mubbashir Muzzammil Khan, MD
• Vicki Kirkland, M. ED. CF-SLP
• Gregory J Kramer, D.P.M.
• Megan Lambert, MS, RD, LD
• Larry Hutchison DC PC
• Haley Sellers Lewis, NP-C
• Lisa Lewis, SLP
• Macy Leigh Lewis, OT
• Mary Anne Lewis

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.