Organization
DECLEENE OPTOMETRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRANK M. DECLEENE III O.D. (OPTOMETRIST)
(765) 453-5005
Entity
Organization
Contact information
Practice address
608 E BOULEVARD, KOKOMO, IN 46902-2286
(765) 453-5005
(765) 453-8937
Mailing address
608 E BOULEVARD, KOKOMO, IN 46902-2286
(765) 453-5005
(765) 453-8937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002523A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100341590
—
IN
05
—
100341640
—
IN
05
—
100420590A
—
IN
Enumeration date
01/24/2007
Last updated
11/06/2014
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