Individual
RANDY FORTKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
711 N RIVER DR, MARION, IN 46952-2672
(765) 664-9637
Mailing address
3750 N TROY AVE, MARION, IN 46952-9792
(260) 251-5533
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004260A
IN
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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