Healthcare Provider Details

I. General information

NPI: 1265946362
Provider Name (Legal Business Name): CORYDON OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EDSEL LN NW
CORYDON IN
47112-2168
US

IV. Provider business mailing address

2000 EDSEL LN NW
CORYDON IN
47112-2168
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-1707
  • Fax:
Mailing address:
  • Phone: 812-738-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: FRED A HIGGINS
Title or Position: PRESIDENT
Credential:
Phone: 812-738-1707