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Deactivated NPI 1417936279 Deactivated / Inactive NPI Male Practitioner

Larry E Forth

Optometrist • Douglas, GA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Larry Forth has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 11, 2006
NPI Deactivation Date September 20, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Larry Forth was a registered Optometrist practicing in Douglas, GA. Throughout an active medical career spanning 17 years, Larry Forth provided care at the practice location at 200 DOCTORS DR until profile deactivation on 2023-09-20.

Practice Location & Contact Primary Location

Practice Address

200 Doctors Dr
Suite 105

Douglas, GA 315332201

Telephone 9123841840
Fax 9123845976
Associated Practice Facility / Clinic
🏢 Coffee Family Medicine, Pc Facility NPI 1265456669

Specialty Benchmarks & Practice Insights

Comparative analytics for Optometrist in Douglas, GA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 28.7 Yrs
State Avg: 22.3 Yrs
Regional Practice Density
5 Specialists

Practicing in Douglas, GA (1498 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Optometrist Primary Specialty

NUCC Taxonomy Code: 152W00000X

State License GA 842T

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

8 Associated Practitioners
Larissa Davis

Nurse Practitioner - Family

NPI 1063832731
Dr. Mark Brulte , MD

Internal Medicine

NPI 1205931672

Doctor of Medicine (M.D.)

Dr. John Arnett , MD

Internal Medicine

NPI 1225021678

Doctor of Medicine (M.D.)

NPI 1255311619

Doctor of Medicine (M.D.)

Debra Luke , FNP-C

Nurse Practitioner - Family

NPI 1427305507

Family Nurse Practitioner (Certified)

NPI 1538135454

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated September 20, 2023

Record deactivated on September 20, 2023

NPI Profile Active August 09, 2010

NPI status registered as active in NPPES database

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Updated Practice Location August 09, 2010

Registered at 200 DOCTORS DR, SUITE 105, DOUGLAS, GA 315332201 (Tel: 9123841840)

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Updated Business Mailing Address August 09, 2010

Registered at PO BOX 2740, DOUGLAS, GA 315342740 (Tel: 9123841840)

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Provider Name / Credentials Updated August 09, 2010

Recorded as LARRY FORTH

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 09, 2010

Optometrist (License #842T in GA)

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Initial NPI Registration & Enumeration January 11, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1417936279
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 11, 2006
Last Update: August 09, 2010
Deactivation Date: September 20, 2023

Mailing Address

Po Box 2740

Douglas, GA 315342740

Phone: 9123841840

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.