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Organization

DRS. ROUSH & WILL OPTOMETRISTS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT ALAN ROUSH O.D. (PRESIDENT)
(260) 347-3611
Entity
Organization

Contact information

Practice address
809 LINCOLNWAY SOUTH, LIGONIER, IN 46767-1700
(260) 894-3909
(260) 894-3904
Mailing address
117 W RUSH ST, KENDALLVILLE, IN 46755-1739
(260) 347-3458
(260) 347-4425

Taxonomy

Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
56000032A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100355140A
IN
05
100355140B
IN
05
100355140C
IN
01
967880
MEDICARE PTAN
IN
Enumeration date
02/10/2012
Last updated
02/13/2012
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