Provider Demographics
NPI:1811243231
Name:DR CHRISTY A OSBORNE AND ASSOCIATES, PC
Entity type:Organization
Organization Name:DR CHRISTY A OSBORNE AND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-289-1193
Mailing Address - Street 1:424 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-1585
Mailing Address - Country:US
Mailing Address - Phone:765-289-1193
Mailing Address - Fax:765-286-5992
Practice Address - Street 1:424 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1585
Practice Address - Country:US
Practice Address - Phone:765-289-1193
Practice Address - Fax:765-286-5992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002129B152W00000X
ININ18002129B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100134950CMedicaid
IN5604250001Medicare NSC
INT69247Medicare UPIN
T69247Medicare UPIN
467700Medicare PIN
IN100134950CMedicaid