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NPI Code Detail

MEDICARE: DR. RENEE MARIE COLLIER O.D.

MEDICARE: DR. RENEE MARIE COLLIER 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
1152W00000XOptometrist18003297AIN

General Provider Information

NPI Number : 1366529158
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RENEE MARIE COLLIER O.D.
Provider Business Mailing Address
First Line : 5150 FRANKLIN ST
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-7878
Country : US
Telephone Number : 219-879-6082
Fax Number : 219-879-6395
Provider Business Practice Location Address
First Line : 5150 FRANKLIN ST
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-7878
Country : US
Telephone Number : 219-879-6082
Fax Number : 219-879-6395
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 02/28/2013

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