Organization
BULLOCK OPTOMETRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN N BULLOCK OD (PRESIDENT)
(317) 417-0603
Entity
Organization
Contact information
Practice address
2373 E MAIN ST, PLAINFIELD, IN 46168-2717
(317) 839-0713
Mailing address
114 KINGSVIEW DR, MOORESVILLE, IN 46158-2734
(317) 417-0603
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002990A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200918100A
—
IN
05
—
200918100B
—
IN
Enumeration date
05/27/2008
Last updated
12/16/2008
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