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NPI Code Detail

MEDICARE: EMBREE OPTOMETRY PC

MEDICARE: EMBREE OPTOMETRY PC
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
1152W00000XOptometrist18002923AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982082855
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMBREE OPTOMETRY PC
Provider Business Mailing Address
First Line : 1710 APPLE GLEN BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1725
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1710 APPLE GLEN BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1725
Country : US
Telephone Number : 260-432-8908
Fax Number : 260-432-8125
Authorized Official
Title or Position : OWNER
Name : RODNEY C EMBREE
Credential :
Telephone Number : 260-432-8908
Provider Enumeration Date : 05/12/2015
Last Update Date : 05/12/2015

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Directions to “EMBREE OPTOMETRY PC ” Practice Location

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