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Organization

FAMILY EYE CARE OF SOUTH BEND

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT LESLIE PROUDFIT O.D. (OWNER)
15742893937
Entity
Organization

Contact information

Practice address
220 NORTH IRONWOOD, SOUTH BEND, IN 46615-1623
(157) 428-7088
(157) 428-7895
Mailing address
220 N IRONWOOD DR, SOUTH BEND, IN 46615-2518
(157) 428-7088
(157) 428-0735

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001502B
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0205890001
DEMARC
IN
01
251850A
MEDICARE ID
IN
Enumeration date
02/01/2007
Last updated
12/21/2007
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