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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