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General NPI Number Information
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NPI Number | 1962069088
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Entity Type | Organization
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Legal Business Name | DEI OF INDIANA, INC.
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 3985 W. 106TH STREET SUITE 120
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 574-876-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 2312 E JACKSON BLVD
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City | ELKHART
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State | IN
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Zip | 46516-4640
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Country | US
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Telephone | 574-876-0974
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DAVID R BRITZKE
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Credential | O.D.
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Telephone | 574-876-0974
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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 |
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License Number State |
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