Healthcare Provider Details

I. General information

NPI: 1821085788
Provider Name (Legal Business Name): DON R DOWNING J D ROBERTS & D BARRY DOWNING PTRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N WALNUT ST
SEYMOUR IN
47274-2113
US

IV. Provider business mailing address

321 N WALNUT ST
SEYMOUR IN
47274-2113
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-4444
  • Fax: 812-522-2634
Mailing address:
  • Phone: 812-522-4444
  • Fax: 812-522-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001504A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001976A
License Number StateIN

VIII. Authorized Official

Name: DR. D BARRY DOWNING
Title or Position: OWNER
Credential:
Phone: 812-522-4444