Active NPI
Charles Richard Ford, M.D.
- Ophthalmology Physician
- Shawnee, KS
National Provider Identifier
1689801441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 04-13088
- Practice address
- 4742 Black Swan Drive
Shawnee, KS 66216 - Phone
- (913) 268-0265
- Fax
- (913) 768-8210
- NPI assigned
- Jun 18, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 04-13088 | KS | Primary |
Addresses
Primary practice location
4742 Black Swan Drive
Shawnee, KS 66216
Mailing address
4742 Black Swan Drive
Shawnee, KS 66216
Phone (913) 268-0265
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04-13088 | Other | KS | KANSAS STATE BOARD OF HEALING ARTS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-13088 | KS | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245283200000",
"number": "1689801441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4742 BLACK SWAN DRIVE",
"city": "SHAWNEE",
"state": "KS",
"postal_code": "66216",
"telephone_number": "913-268-0265",
"fax_number": "913-768-8210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4742 BLACK SWAN DRIVE",
"city": "SHAWNEE",
"state": "KS",
"postal_code": "66216",
"telephone_number": "913-268-0265",
"fax_number": "913-768-8210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORD",
"first_name": "CHARLES",
"middle_name": "RICHARD",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-18",
"last_updated": "2009-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "KS",
"license": "04-13088",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KANSAS STATE BOARD OF HEALING ARTS",
"identifier": "04-13088",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.