Provider Demographics
NPI:1881744894
Name:IMES, DAVID R (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:IMES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-0760
Practice Address - Street 1:611 E DOUGLAS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-271-1114
Practice Address - Fax:574-271-1644
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201148680Medicaid
IN66920020Medicare PIN
IN201148680Medicaid
IN452570032Medicare PIN