Organization Name: | RENAISSANCE OCULAR DISEASE AND TRAUMA FOUNDATION, INC. |
NPI Number: | 1174740682 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICKY LEE WEIDOW (PRESIDENT) |
Mailing Address: | 201 W Wayne St Lagrange |
State: | IN US |
Postal Code: | 467611850 |
Phone Number: | 2604633421 |
Fax Number: | 2604637347 |
NPI Enumeration Date: | 04/19/2007 |
NPI Last Update Date: | 02/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | 18002670A/B |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |