Diana Gail Ford | Canton, GA • PECOS Search

Diana Gail Ford

Optometrist

Eye and Vision Services Providers

1550 Riverstone Pkwy, Canton, GA 30114-2918

(770) 720-1023 (770) 557-5869

PECOS Enrollment

Based on the most recent information from CMS, provider Diana Gail Ford does not have current enrollment records in PECOS.

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

CMS last updated its PECOS records 11 days ago.

Profile Details

Provider ID
1811273899
Provider Type
Individual
Full Name
Ford, Diana Gail
Title
Dr.
Credential
O.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
10/23/2011
Last Updated
7/1/2022

Contact Information

Practice Location

1550 Riverstone Pkwy, Canton, GA 30114-2918

Unlisted Fax

Mailing Location

108 Linkside Ct, Woodstock, GA 30189-2515

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License 2635 Georgia