One Source Vision Care
Organization Active NPI Optometrist · Boonville, IN
NPI 1437463288 · NPPES record last updated Sep 17, 2012
Key facts
- NPI
- 1437463288
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 18001663A (IN)
- Legal business name
- ONE SOURCE VISION CARE
- Practice address
- 966 Aigner Dr
Boonville, IN 47601-8471 - Phone
- (812) 897-8900
- Fax
- (801) 218-0060
- NPI assigned
- Aug 4, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. David N Phillips, O.D.
- Title
- President
- Phone
- (812) 897-8900
National Provider Directory
Locations
966 Aigner Dr
Boonville, IN 47601
Phone (812) 897-8900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 18001663A | IN | Yes |
Addresses
Primary practice location
966 Aigner Dr
Boonville, IN 47601-8471
Mailing address
966 Aigner Dr
Boonville, IN 47601-8471
Phone (812) 897-8900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100254340 | Medicaid | IN |
Other providers in Boonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.