Organization
JERRY D WARTHMAN, O.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY DALE WARTHMAN OD (OWNER)
(765) 644-0060
Entity
Organization
Contact information
Practice address
1923 W 53RD ST, ANDERSON, IN 46013-1109
(765) 644-0060
(765) 644-0076
Mailing address
1923 W 53RD ST, ANDERSON, IN 46013-1109
(765) 644-0060
(765) 644-0076
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002286A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100331000B
—
IN
05
—
200953040
—
IN
Enumeration date
08/04/2008
Last updated
04/28/2010
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