Provider Demographics
NPI:1235359480
Name:OPTOMETRIC ASSOCIATES OF SOUTH BEND
Entity Type:Organization
Organization Name:OPTOMETRIC ASSOCIATES OF SOUTH BEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-289-3937
Mailing Address - Street 1:220 N IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2518
Mailing Address - Country:US
Mailing Address - Phone:574-289-3937
Mailing Address - Fax:574-280-7355
Practice Address - Street 1:220 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2518
Practice Address - Country:US
Practice Address - Phone:574-289-3937
Practice Address - Fax:574-280-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN152W00000XOtherTAXONOMY
IN152W00000XOtherTAXONOMY