Provider Demographics
NPI:1073166013
Name:VERONICA CAMARILLO OD PC
Entity Type:Organization
Organization Name:VERONICA CAMARILLO OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMARILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-973-3712
Mailing Address - Street 1:1330 W 4TH PL
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-4918
Mailing Address - Country:US
Mailing Address - Phone:219-973-3712
Mailing Address - Fax:
Practice Address - Street 1:6050 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5047
Practice Address - Country:US
Practice Address - Phone:219-762-7862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200489900Medicaid