Individual
MR. JOSEPH VINCENT DE SPIRITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1105 S COLLEGE MALL ROAD, HOOSIER EYE DOCTOR, BLOOMINGTON, IN 47401-6177
(812) 333-2020
(812) 334-2020
Mailing address
1105 S COLLEGE MALL ROAD, HOOSIER EYE DOCTOR, BLOOMINGTON, IN 47401-6177
(812) 323-2020
(812) 334-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003199A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11478711
CAQH
—
05
—
200411980
—
IN
05
—
200411980A
—
IN
Enumeration date
11/17/2006
Last updated
03/26/2019
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