| |
350 S Van Buren St, Suite 2b, Shipshewana, IN 46565-9197 | |
(260) 768-7721 | |
(260) 768-7747 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 350 S Van Buren St, Shipshewana, Indiana |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1952607780 | NPI | - | NPPES |
100082470W | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 56000164A (Indiana) | Primary |
Mailing Address | Practice Location Address |
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Po Box 549, Wabash, IN 46992-0549 Ph: (260) 569-9550 | 350 S Van Buren St, Suite 2b, Shipshewana, IN 46565-9197 Ph: (260) 768-7721 |