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General NPI Number Information
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NPI Number | 1902893571
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Entity Type | Individual
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Provider Name | RICKY W BARON O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 710 S 13TH ST
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City | DECATUR
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State | IN
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Zip | 46733-1802
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Country | US
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Telephone | 260-724-4318
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Fax | 260-724-9776
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | WABASH
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State | IN
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Zip | 46992-0549
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Country | US
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Telephone | 260-569-9550
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Fax | 260-569-0760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 18001733B
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License Number State | IN
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