Individual
DR. DOUGLAS ERIC WIDMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4121 S. MICHIGAN STREET, SOUTH BEND, IN 46614-2545
(574) 291-9200
(574) 299-4423
Mailing address
4121 S. MICHIGAN STREET, SOUTH BEND, IN 46614-2545
(574) 291-9200
(574) 299-4423
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003697A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201034430
—
IN
Enumeration date
09/19/2011
Last updated
03/25/2013
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