1194945881 NPI number — RICHARD & ARMSTRONG OPTOMETRY

Table of content: (NPI 1194945881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194945881 NPI number — RICHARD & ARMSTRONG OPTOMETRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD & ARMSTRONG OPTOMETRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194945881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 S. S.R 135
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46143-2385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-887-2800
Provider Business Mailing Address Fax Number:
317-887-2958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 S. S.R 135
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46143-2385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-887-2800
Provider Business Practice Location Address Fax Number:
317-300-0078
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARMSTRONG
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
317-887-2800

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000364685 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: DD2587 . This is a "PALMETTO GBA-RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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