Organization
DEBOER OD LTD
Active
Other names
DeBoer Family Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J DEBOER OD (PRESIDENT)
(219) 987-3673
Entity
Organization
Contact information
Practice address
609 N HALLECK ST, DEMOTTE, IN 46310-9545
(219) 987-3673
Mailing address
PO BOX 849, 609 N. HALLECK STREET, DEMOTTE, IN 46310-0849
(219) 987-3673
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002342
IN
Other
Enumeration date
08/08/2006
Last updated
12/29/2011
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