Individual
STEVEN ISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 LAKE AVE, FORT WAYNE, IN 46805-5500
(260) 426-3095
Mailing address
3401 LAKE AVE, FORT WAYNE, IN 46805-5500
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004057A
IN
Other
Enumeration date
07/12/2017
Last updated
07/17/2017
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