| |
3343 Michael Ave, Bedford, IN 47421 | |
(812) 279-3466 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 3343 Michael Ave, Bedford, Indiana |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1871743716 | NPI | - | NPPES |
200870690 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 18003463 (Indiana) | Secondary |
332H00000X | Eyewear Supplier | 0133742008-000 (Indiana) | Primary |
Mailing Address | Practice Location Address |
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3343 Michael Ave, Bedford, IN 47421-3535 Ph: (812) 279-3466 | 3343 Michael Ave, Bedford, IN 47421 Ph: (812) 279-3466 |