Provider Demographics
NPI:1649486077
Name:ASHMAN OLINGER WILSON & KLEM
Entity type:Organization
Organization Name:ASHMAN OLINGER WILSON & KLEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERILYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-288-7744
Mailing Address - Street 1:1904 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2264
Mailing Address - Country:US
Mailing Address - Phone:765-288-7744
Mailing Address - Fax:765-282-0741
Practice Address - Street 1:1904 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2264
Practice Address - Country:US
Practice Address - Phone:765-288-7744
Practice Address - Fax:765-282-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100460750AMedicaid