Organization
MARION FAMILY OPTOMETRISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC E DALE O.D. (PRESIDENT)
(765) 662-6648
Entity
Organization
Contact information
Practice address
905 MANCHESTER AVE, WABASH, IN 46992-1639
(260) 563-0884
Mailing address
905 MANCHESTER AVE, WABASH, IN 46992-1639
(260) 563-0884
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
18001734B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100253710A
—
IN
05
—
100253710B
—
IN
Enumeration date
12/17/2007
Last updated
07/23/2024
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