| |
321 E Wayne St, Fort Wayne, IN 46802-2713 | |
(260) 424-5656 | |
(260) 424-4511 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 321 E Wayne St, Fort Wayne, Indiana |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1538216023 | NPI | - | NPPES |
2858064 | Medicaid | OH | |
100256600J | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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Po Box 457, Richmond, IN 47375-0457 Ph: (765) 966-7345 | 321 E Wayne St, Fort Wayne, IN 46802-2713 Ph: (260) 424-5656 |