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NPI Code Detail

MEDICARE: DR. MONA RUTH DEWART O.D.

MEDICARE: DR. MONA RUTH DEWART O.D.
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
1152W00000XOptometrist18002368BIN

General Provider Information

NPI Number : 1306844501
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MONA RUTH DEWART O.D.
Provider Business Mailing Address
First Line : 5014 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6804
Country : US
Telephone Number : 260-432-4060
Fax Number : 260-436-7475
Provider Business Practice Location Address
First Line : 5014 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6804
Country : US
Telephone Number : 260-432-4060
Fax Number : 260-436-7475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/09/2007

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