Provider Demographics
NPI:1568609832
Name:FARLOW ENTERPRISES, INC.
Entity Type:Organization
Organization Name:FARLOW ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-563-2020
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0647
Mailing Address - Country:US
Mailing Address - Phone:260-563-2020
Mailing Address - Fax:260-563-2873
Practice Address - Street 1:144 W HILL ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-3048
Practice Address - Country:US
Practice Address - Phone:260-563-2020
Practice Address - Fax:260-563-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002054A152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN134927OtherEYEMED VISION CARE
IN100253500BMedicaid
IN000000088323OtherANTHEM BLUE CROSS
IN6194560001Medicare NSC
IN134927OtherEYEMED VISION CARE
IN861260Medicare PIN