Provider Demographics
NPI:1437509007
Name:RUSH, COLLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:
Last Name:RUSH
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 1:1160 N STATE ROAD 135
Mailing Address - Street 2:# A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1019
Mailing Address - Country:US
Mailing Address - Phone:317-213-6201
Mailing Address - Fax:
Practice Address - Street 1:1160 N STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1019
Practice Address - Country:US
Practice Address - Phone:317-865-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003967A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist