Individual
JERRY W LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2519 E MAIN ST, RICHMOND, IN 47374-5867
(765) 966-2661
(765) 965-4789
Mailing address
2517 EAST MAIN STREET, RICHMOND, IN 47374-5867
(765) 966-2661
(765) 965-4789
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001503B
IN
Other
Enumeration date
12/11/2006
Last updated
04/10/2008
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