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NPI Code Detail

MEDICARE: STEVEN ISON

MEDICARE: STEVEN ISON
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
1152W00000XOptometrist18004057AIN

General Provider Information

NPI Number : 1083136030
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN ISON
Provider Business Mailing Address
First Line : 3401 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5500
Country : US
Telephone Number :
Fax Number :
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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2017
Last Update Date : 07/17/2017

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Directions to “ STEVEN ISON ” Practice Location

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