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9270 Wicker Ave, Suite A, St. John, IN 46373 | |
(219) 365-1227 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 9270 Wicker Ave, St. John, Indiana |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1073804449 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 18003351A (Indiana) | Primary |
Provider Name | Valerie Renee Anderson |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1154489177 PECOS PAC ID: 0446286223 Enrollment ID: I20050713000233 |
Mailing Address | Practice Location Address |
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9270 Wicker Ave, Suite A, St. John, IN 46373 Ph: (219) 365-1227 | 9270 Wicker Ave, Suite A, St. John, IN 46373 Ph: (219) 365-1227 |