Individual
DR. JACK DERBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
506 S WASHINGTON ST, MARION, IN 46953-1961
(765) 662-6648
(765) 662-6250
Mailing address
506 S WASHINGTON ST, MARION, IN 46953-1961
(765) 662-6648
(765) 662-6250
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003896A
IN
Other
Enumeration date
06/15/2015
Last updated
06/15/2015
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