Weidow, Ricky Lee
Weidow, Ricky Lee is an individual health care provider with primary practice located at 201 W Wayne St , Lagrange IN 46761-1850. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Pediatrics. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Weidow, Ricky Lee can be contacted via phone (260) 463-3421.Contact Information
Primary practice address
201 W Wayne St
Lagrange IN 46761-1850
Phone: (260) 463-3421
Fax: (260) 463-7347
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 18002670A/B | Indiana |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 18002670A/B | Indiana |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | 18002670A/B | Indiana |
Profile Details
| NPI number | 1639177793 |
|---|---|
| LBN Legal business name | Weidow, Ricky Lee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2005 |
| Last updated | Feb 14th, 2010 - 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 | 1639177793 | NPPES |
| Indiana | Other | 000000635212 | ANTHEM BC/BS NWIELC KNOX |
| Indiana | Other | 2604633421 | ANTHEM BC/BS NWIELC KNOX |
| Indiana | Other | 5742334109 | ANTHEM BC/BS NWIELC KNOX |
| Indiana | Other | 2605932505 | ANTHEM BC/BS NWIELC KNOX |
| Indiana | Other | 000000257711 | ANTHEM BC/BS NWIELC KNOX |
| Indiana | Other | 000000257712 | ANTHEM BC/BS NWIELC KNOX |
| Indiana | Other | 1174740682 | ANTHEM BC/BS NWIELC KNOX |
| Indiana | MEDICAID | 200097680C | ANTHEM BC/BS NWIELC KNOX |
| Indiana | MEDICAID | 200097680E | ANTHEM BC/BS NWIELC KNOX |
| Indiana | MEDICAID | 200097680D | ANTHEM BC/BS NWIELC KNOX |
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