Organization
FORT WAYNE OPHTHALMIC SURGICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN REX PARENT (OWNER)
(260) 424-5656
Entity
Organization
Contact information
Practice address
321 E. WAYNE STREET, FORT WAYNE, IN 46802-2713
(260) 422-5976
(260) 969-1041
Mailing address
321 E. WAYNE STREET, FORT WAYNE, IN 46802-2713
(260) 422-5976
(260) 969-1041
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097949
ANTHEM PIN
IN
Enumeration date
01/24/2008
Last updated
02/22/2008
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