Individual
JEAN-PAUL ETIENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2901 S MCINTIRE DR STE 120, BLOOMINGTON, IN 47403-4209
(812) 332-1401
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003348A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200528930A
—
IN
Enumeration date
11/16/2005
Last updated
11/05/2021
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