Organization
BALOG BREMEN VISION CENTER P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROLYN M BALOG O.D. (PRESIDENT)
(574) 546-3820
Entity
Organization
Contact information
Practice address
1425 W PLYMOUTH ST, BREMEN, IN 46506-1951
(574) 546-3820
(574) 546-3810
Mailing address
1425 W PLYMOUTH ST, BREMEN, IN 46506-1951
(574) 546-3820
(574) 546-3810
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001983A
IN
332H00000X
Eyewear Supplier
18001983A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA1502
RAILROAD MEDICARE
IN
Enumeration date
09/16/2006
Last updated
01/22/2008
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