Warthman, Jerry Dale
Warthman, Jerry Dale is an sole proprietor health care provider with primary practice located at 1923 W 53Rd St , Anderson IN 46013-1109. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Warthman, Jerry Dale can be contacted via phone (765) 644-0060.Contact Information
Primary practice address
1923 W 53Rd St
Anderson IN 46013-1109
Phone: (765) 644-0060
Fax: (765) 644-0076
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 18002286 A | Indiana |
Profile Details
| NPI number | 1063493906 |
|---|---|
| LBN Legal business name | Warthman, Jerry Dale |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 8th, 2005 |
| Last updated | Apr 28th, 2010 - about 15 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 | 1063493906 | NPPES |
| Indiana | MEDICAID | 100331000B | |
| Indiana | MEDICAID | 200953040 |
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