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Organization

INDIANA VISION DEVELOPMENT CENTER PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CARL O MYERS OD (PRESIDENT)
(260) 497-7973
Entity
Organization

Contact information

Practice address
10343 DAWSONS CREEK BLVD, STE B BLDG 6, FORT WAYNE, IN 46825-1906
(260) 497-7973
(260) 497-7986
Mailing address
10343 DAWSONS CREEK BLVD, STE B BLDG 6, FORT WAYNE, IN 46825-1906
(260) 497-7973
(260) 497-7986

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002177A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200427750A
IN
01
5544260001
DMEPOS
IN
Enumeration date
04/01/2006
Last updated
10/17/2007
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