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Organization

INDIANA VISION CLINIC, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RONALD MILOVICH OD (OWNER/OPTOMETRIST)
(574) 288-2400
Entity
Organization

Contact information

Practice address
2004 EDISON RD, SUITE A, SOUTH BEND, IN 46617-1712
(574) 288-2400
(574) 288-7132
Mailing address
2004 EDISON RD, SUITE A, SOUTH BEND, IN 46617-1712
(574) 288-2400
(574) 288-7132

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001593B
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000273027
BLUE CROSS BLUE SHIELD
IN
01
01171
SPECTERA
IN
05
200380990
IN
Enumeration date
06/11/2006
Last updated
10/21/2010
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