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NPI Code Detail

MEDICARE: SOUTH BEND OPTOMETRICS, LLC

MEDICARE: SOUTH BEND OPTOMETRICS, LLC
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
1152WL0500XLow Vision Rehabilitation Optometrist18003629AIN

General Provider Information

NPI Number : 1629360151
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH BEND OPTOMETRICS, LLC
Provider Business Mailing Address
First Line : 2933 CAROLINE ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-1545
Country : US
Telephone Number : 574-386-2738
Fax Number :
Provider Business Practice Location Address
First Line : 2933 CAROLINE ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-1545
Country : US
Telephone Number : 574-386-2738
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. YAIR S ELIAS
Credential : O.D.
Telephone Number : 574-386-2738
Provider Enumeration Date : 05/02/2011
Last Update Date : 05/02/2011

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Directions to “SOUTH BEND OPTOMETRICS, LLC ” Practice Location

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