Provider Demographics
NPI:1548393432
Name:PAUL R. HONAN, JR MD INC
Entity Type:Organization
Organization Name:PAUL R. HONAN, JR MD INC
Other - Org Name:LEBANON OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HONAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:765-482-1954
Mailing Address - Street 1:1720 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1501
Mailing Address - Country:US
Mailing Address - Phone:765-482-1954
Mailing Address - Fax:
Practice Address - Street 1:1720 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1501
Practice Address - Country:US
Practice Address - Phone:765-482-1954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL R HONAN, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01015185332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000082477OtherBCBS
181760398OtherMEDICARE RET RAILROAD
IN100062980Medicaid
INC24351Medicare UPIN
IN100062980Medicaid