Organization
ABBOTT EYE CLINIC INC PC
Active
Other names
Image Optical
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH W ABBOTT MD (PRESIDENT OWNER)
(574) 294-3030
Entity
Organization
Contact information
Practice address
2222 W LEXINGTON AVE, ELKHART, IN 46514-1420
(574) 294-3030
(574) 294-3544
Mailing address
2222 W LEXINGTON AVE, ELKHART, IN 46514-1420
(574) 294-3030
(574) 294-3544
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4018880001
DMER
IN
Enumeration date
11/08/2006
Last updated
10/19/2012
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