Provider Demographics
NPI:1043233141
Name:CORBIN, JOHN C (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:CORBIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2006
Mailing Address - Country:US
Mailing Address - Phone:574-583-9311
Mailing Address - Fax:574-583-4939
Practice Address - Street 1:501 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2006
Practice Address - Country:US
Practice Address - Phone:574-583-9311
Practice Address - Fax:574-583-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001712A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151130AMedicare PIN
T69306Medicare UPIN