Provider Demographics
NPI:1376515411
Name:NORMAN, GREGORY D (O D)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:NORMAN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:D
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:O D
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-0275
Mailing Address - Country:US
Mailing Address - Phone:765-564-2800
Mailing Address - Fax:765-564-2477
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1327
Practice Address - Country:US
Practice Address - Phone:765-564-2800
Practice Address - Fax:765-564-2477
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090679OtherDELPHI
IN100088980Medicaid
IN000000090678OtherFRANKFORT
IN000000090678OtherFRANKFORT
IN100088980Medicaid
IN000000090679OtherDELPHI
IN410028924Medicare ID - Type UnspecifiedTRAVELERS