Healthcare Provider Details

I. General information

NPI: 1568609832
Provider Name (Legal Business Name): FARLOW ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W HILL ST
WABASH IN
46992-3048
US

IV. Provider business mailing address

PO BOX 647
WABASH IN
46992-0647
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-2020
  • Fax: 260-563-2871
Mailing address:
  • Phone: 260-563-2020
  • Fax: 260-563-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number18002054A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number18002054A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number18002054A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number18002054A
License Number StateIN

VIII. Authorized Official

Name: MRS. JANEL PROFFITT
Title or Position: OFFICE MANAGER
Credential:
Phone: 206-563-2020