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Samantha Kaye Ford

Optometrist

Eye and Vision Services Providers

PECOS Enrollment

This provider is enrolled in PECOS as SAMANTHA FORD.

Based on the most recent information from CMS, provider Samantha Kaye Ford is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1962261529
Provider Type
Individual
Full Name
Ford, Samantha Kaye
Gender
Female

Sole Proprietor
No
Enumeration Date
3/18/2024
Last Updated
5/21/2024

Contact Information

Practice Location

265 N Liberty St, Powell, OH 43065-8870

(614) 793-0700

Unlisted Fax

Mailing Location

265 N Liberty St, Powell, OH 43065-8870

(614) 793-0700

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License OPT.007285 Ohio

Samantha Kaye Ford

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

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