Provider Demographics
NPI:1821085788
Name:DON R DOWNING J D ROBERTS & D BARRY DOWNING PTRS
Entity Type:Organization
Organization Name:DON R DOWNING J D ROBERTS & D BARRY DOWNING PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-522-4444
Mailing Address - Street 1:321 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2113
Mailing Address - Country:US
Mailing Address - Phone:812-522-4444
Mailing Address - Fax:812-522-2634
Practice Address - Street 1:321 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2113
Practice Address - Country:US
Practice Address - Phone:812-522-4444
Practice Address - Fax:812-522-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001976A152W00000X
IN18001504A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100460230AMedicaid
IN100460230AMedicaid