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General NPI Number Information
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NPI Number | 1538219498
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Entity Type | Organization
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Legal Business Name | ODON OPTICAL, INC.
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 101 E ELNORA ST
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City | ODON
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State | IN
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Zip | 47562-1125
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Country | US
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Telephone | 812-636-8030
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Fax | 812-636-4898
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Provider Business Mailing Address
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Address Line | 101 E ELNORA ST
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City | ODON
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State | IN
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Zip | 47562-1125
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Country | US
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Telephone | 812-636-8030
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Fax | 812-636-4898
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. C DAVID WINTERGERST
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Credential | O.D.
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Telephone | 812-636-8030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 18002037
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License Number State | IN
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