Healthcare Provider Details

I. General information

NPI: 1265688816
Provider Name (Legal Business Name): R W BARON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S 13TH ST
DECATUR IN
46733-1802
US

IV. Provider business mailing address

710 S 13TH ST
DECATUR IN
46733-1802
US

V. Phone/Fax

Practice location:
  • Phone: 260-724-4318
  • Fax: 260-724-9776
Mailing address:
  • Phone: 260-724-4318
  • Fax: 260-724-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateIN

VIII. Authorized Official

Name: RICK W BARON
Title or Position: OWNER
Credential: O.D.,F.A.A.O.
Phone: 260-724-4318