Shane Ford, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2505 Issued in AR

Practice address

3005 Fountain Drive
Conway, AR 72034-3684

Phone

(501) 329-9851

Fax

(501) 329-9854

NPI assigned

Mar 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shane E Ford OD PAGroup PAC ID 3678529575, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sfordod@arkansaseyecaregroup.eyefinity-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shane E. Ford OD PA

  • Optometrist
  • Conway, AR
  • NPI 1033178736

  AR, Optometrist

  Medicare reassignment Care Compare group NPD Authorized official
• George Schroeder, M.D., P.a.

  • Ophthalmology Physician
  • Little Rock, AR
  • NPI 1457553869
  NPD (past)

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1497714075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3005 FOUNTAIN DRIVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720343684",
            "telephone_number": "501-329-9851",
            "fax_number": "501-329-9854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 FOUNTAIN DRIVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720343684",
            "telephone_number": "501-329-9851",
            "fax_number": "501-329-9854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2007-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2505",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "AR",
            "license": "2505",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "AR",
            "license": "2505",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "AR",
            "license": "2505",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140746722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trudy Davis Forbush, PHYSICAL THERAPIST
• Charlanda Ford, LPC
• Chelcie Ford, M.S. CF-SLP
• Madeline Jane Ford
• Madison Leigh Ford, APRN
• Alex Foree, OD
• Marian Forrest, MS, SLP
• Aaron Kyle Forrester, D.D.S.
• Sheila Forrester, APRN
• Leigh Anne Fortner, SLP

• All providers in Conway, AR
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.