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Organization

UNIVERSITY PARK VISION CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. AMY REIDHAAR OD (OPTOMETRIST)
(260) 471-2000
Entity
Organization

Contact information

Practice address
1221 MEDICAL PARK DR, FORT WAYNE, IN 46825-5887
(260) 471-2000
(260) 471-2100
Mailing address
10723 KNOLLTON RUN, FORT WAYNE, IN 46818-8746
(260) 705-2285

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
152WC0802X
Corneal and Contact Management Optometrist
152WP0200X
Pediatric Optometrist
332H00000X
Eyewear Supplier

Other

Enumeration date
10/09/2021
Last updated
11/23/2021
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