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General NPI Number Information
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NPI Number | 1780739540
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Entity Type | Organization
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Legal Business Name | DECLEENE OPTOMETRY, INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 608 E BOULEVARD
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City | KOKOMO
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State | IN
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Zip | 46902-2286
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Country | US
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Telephone | 765-453-5005
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Fax | 765-453-8937
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Provider Business Mailing Address
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Address Line | 608 E BOULEVARD
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City | KOKOMO
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State | IN
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Zip | 46902-2286
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Country | US
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Telephone | 765-453-5005
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Fax | 765-453-8937
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. FRANK M. DECLEENE III
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Credential | O.D.
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Telephone | 765-453-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002523A
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License Number State | IN
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