Dougherty, Kurt W.
Dougherty, Kurt W. is an sole proprietor health care provider with primary practice located at 3401 Lake Ave , Fort Wayne IN 46805-5500. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Dougherty, Kurt W. can be contacted via phone (260) 422-6396.Contact Information
Primary practice address
3401 Lake Ave
Fort Wayne IN 46805-5500
Phone: (260) 422-6396
Fax: (260) 420-2258
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1800214R | Indiana |
Profile Details
| NPI number | 1295727519 |
|---|---|
| LBN Legal business name | Dougherty, Kurt W. |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 23rd, 2005 |
| Last updated | Jun 18th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1295727519 | NPPES |
| Indiana | MEDICAID | 100103980A |
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