Ricky Lee Weidow is a Pediatrics in Lagrange, Indiana. Ricky Lee Weidow practices all healthcare services and medical treatments related to Pediatrics. The NPI Number for Ricky Lee Weidow is 1639177793. The last update date is 2010-02-14.
Ricky Lee Weidow's current location address is 201 W Wayne St, Lagrange, Indiana. You can contact this provider via phone number 2604633421 and fax number 2604637347. The mailing address for Ricky Lee Weidow is 201 W Wayne St, Lagrange, Indiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Ricky Lee Weidow |
|---|---|
| Address | 201 W Wayne St, Lagrange, Indiana |
| Phone Number | 2604633421 |
| Fax Number | 2604637347 |
| Sole Proprietor | N |
| Credentials | O.D. |
NPI Number Detail
| NPI Number | 1639177793 |
|---|---|
| Provider Enumeration Date | 2005-07-12 |
| Last Updated Date | 2010-02-14 |
Provider Mailing Address Detail
| Address | 201 W Wayne St |
|---|---|
| City | Lagrange |
| State | Indiana (IN) |
| Post Code | 467611850 |
| Phone Number | 2604633421 |
| Fax Number | 2604637347 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatrics |
|---|---|
| Taxonomy | 152Wp0200X |
| Licence No | 18002670A/B |
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Definition: Optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 635212 | IN | ANTHEM BC/BS NWIELC KNOX | |
| 2604633421 | IN | VISION SERVICE PLAN LAGRANGE | |
| 5742334109 | IN | VISION SERVICE PLAN SOUTH BEND | |
| 2605932505 | IN | VISION SERVICE PLAN TOPEKA | |
| 257711 | IN | ANTHEM BC/BS LAGRANGE | |
| 257712 | IN | ANTHEM BC/BS TOPEKA | |
| 1174740682 | IN | RENAISSANCE OCULAR DISEASE AND | |
| 200097680C | IN | -- | |
| 200097680E | IN | -- | |
| 200097680D | IN | -- |
Post Comment/ Review Below
What is the unique 10-digit identification code issued to Ricky Lee Weidow by the Centers for Medicare & Medicaid Services?
The Ricky Lee Weidow has been assigned the NPI (National Provider Identifier) 1639177793 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Can you provide the Ricky Lee Weidow's physical address?
The Ricky Lee Weidow is physically located at 201 W Wayne St, in the city of Lagrange, IN, with the postal code 467611850.
What is Ricky Lee Weidow's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Ricky Lee Weidow is Pediatrics, and the corresponding taxonomy classification code for this specialized field is 152Wp0200X.
On what date did the Centers for Medicare & Medicaid Services assign the 1639177793 to Ricky Lee Weidow?
The Centers for Medicare & Medicaid Services assigned the 1639177793 to Ricky Lee Weidow on 2005-07-12.
When was the information related to Ricky Lee Weidow most recently updated or refreshed?
The details pertaining to the Ricky Lee Weidow, including its address, specialty, and other relevant information, were last updated or refreshed on 2010-02-14.
NPI Number: 1528061710
Address: 19 Nh Route 104, Meredith, NH