Organization
MARION FAMILY OPTOMETRISTS, INC.
Active
Other names
Family Optometry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC DALE OD (VICE PRESIDENT)
(260) 563-0884
Entity
Organization
Contact information
Practice address
520 MANCHESTER AVE, WABASH, IN 46992-1415
(260) 563-0884
(260) 563-3284
Mailing address
520 MANCHESTER AVE, WABASH, IN 46992-1415
(260) 563-0884
(260) 563-3284
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18001734
IN
152W00000X
Optometrist
Primary
18003449
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100253710B
—
IN
Enumeration date
11/20/2013
Last updated
12/27/2013
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