Kollbaum, Peter S
Kollbaum, Peter S is an individual health care provider with primary practice located at 800 E Atwater Ave , Bloomington IN 47405-3635. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Kollbaum, Peter S can be contacted via phone (812) 855-4447.Contact Information
Primary practice address
800 E Atwater Ave
Bloomington IN 47405-3635
Phone: (812) 855-4447
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 18003057 | Indiana |
Profile Details
| NPI number | 1174592794 |
|---|---|
| LBN Legal business name | Kollbaum, Peter S |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 16th, 2006 |
| Last updated | Oct 21st, 2015 - about 9 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 | 1174592794 | NPPES |
| Indiana | MEDICAID | 200284900 |
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