Individual
KURT S PETRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
357C W MORGAN ST, SPENCER, IN 47460-1219
(812) 829-2972
(812) 829-3639
Mailing address
357C W MORGAN ST, SPENCER, IN 47460-1219
(812) 829-2972
(812) 829-3639
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002244B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087919
BCBS
IN
05
—
100193710 C
—
IN
01
—
351787030
COMMERCIAL
IN
01
—
351787030101
CARESOURCE
IN
01
—
410022263
PALMETTO GBA/RAILROAD MEDICARE
IN
01
—
N283918
HARMONY HEALTH
IN
Enumeration date
11/20/2006
Last updated
01/14/2010
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