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General NPI Number Information
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NPI Number | 1972671386
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Entity Type | Organization
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Legal Business Name | OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE PC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 7232 ENGLE RD
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City | FORT WAYNE
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State | IN
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Zip | 46804-2222
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Country | US
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Telephone | 260-436-7205
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Fax | 260-432-1339
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Provider Business Mailing Address
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Address Line | 7232 ENGLE RD
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City | FORT WAYNE
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State | IN
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Zip | 46804-2222
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Country | US
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Telephone | 260-436-7205
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Fax | 260-432-1339
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TRICIA PIEPER
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Credential |
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Telephone | 260-436-7205
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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 | 50002512A
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License Number State | IN
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