Organization
NORTHERN INDIANA OPTOMETRISTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI PESCHKE (COO)
(574) 291-9200
Entity
Organization
Contact information
Practice address
4123 S MICHIGAN ST, SOUTH BEND, IN 46614-2545
(574) 291-9200
(574) 299-4423
Mailing address
4123 S MICHIGAN ST, SOUTH BEND, IN 46614-2545
(574) 291-9200
(574) 299-4423
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001810
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548296718
INDIVIDUAL NPI
IN
05
—
200831530
—
IN
Enumeration date
07/13/2006
Last updated
10/16/2012
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