Healthcare Provider Details

I. General information

NPI: 1932502507
Provider Name (Legal Business Name): ABOITE FAMILY EYECARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 WEST JEFFERSON BLVD
FORT WAYNE IN
46804-4133
US

IV. Provider business mailing address

7625 WEST JEFFERSON BLVD
FORT WAYNE IN
46804-4133
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-1231
  • Fax: 260-969-1568
Mailing address:
  • Phone: 260-432-1231
  • Fax: 260-969-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number351655933
License Number StateIN

VIII. Authorized Official

Name: THOMAS ZACHMAN
Title or Position: OWNER
Credential: O.D
Phone: 260-432-1231