Organization
FORT WAYNE FAMILY EYECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A INGLE O.D. (PRESIDENT)
(260) 744-2273
Entity
Organization
Contact information
Practice address
1515 E PAULDING RD, FORT WAYNE, IN 46816-1252
(260) 744-2273
Mailing address
1515 E PAULDING RD, FORT WAYNE, IN 46816-1252
(260) 744-2273
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000234540
ANTHEM NONPAR
IN
05
—
100277170A
—
IN
Enumeration date
07/08/2006
Last updated
08/08/2008
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