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NPI Code Detail

MEDICARE: DR. GEORGE D TAYLOR OD

MEDICARE: DR. GEORGE D TAYLOR OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist18002045AIN

General Provider Information

NPI Number : 1023098589
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE D TAYLOR OD
Provider Business Mailing Address
First Line : 3401 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5500
Country : US
Telephone Number : 260-426-3095
Fax Number : 260-420-2258
Provider Business Practice Location Address
First Line : 3401 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5500
Country : US
Telephone Number : 260-426-3095
Fax Number : 260-420-2258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 12/05/2007

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Directions to “ DR. GEORGE D TAYLOR OD” Practice Location

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