| Renaissance Ocular Disease And Trauma Foundation, Inc. | |
|
201 W Wayne St, Lagrange, IN 46761-1850 | |
| (260) 463-3421 | |
| (260) 463-7347 |
| Full Name | Renaissance Ocular Disease And Trauma Foundation, Inc. |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 201 W Wayne St, Lagrange, Indiana |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174740682 | NPI | - | NPPES |
| 2605932505 | Other | IN | VISION SERVICE PLAN TOPEKA |
| 5742334109 | Other | IN | VISION SERVICE PLAN SOUTH BEND |
| 200097680D | Medicaid | IN | |
| 2604633421 | Other | IN | VISION SERVICE PLAN LAGRANGE |
| 000000257711 | Other | IN | ANTHEM BC/BS LAGRANGE |
| 000000257712 | Other | IN | ANTHEM BC/BS TOPEKA |
| 000000635212 | Other | IN | ANTHEM NWIELC KNOX |
| 200097680E | Medicaid | IN | |
| 1639177793 | Other | IN | RICKY WEIDOW NPI |
| 200097680C | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 18002670A/B (Indiana) | Primary |
| 332H00000X | Eyewear Supplier | 18002670A/B (Indiana) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Ocular Disease And Trauma Foundation, Inc. 201 W Wayne St, Po Box 150, Lagrange, IN 46761-1850 Ph: (260) 463-3421 | Renaissance Ocular Disease And Trauma Foundation, Inc. 201 W Wayne St, Lagrange, IN 46761-1850 Ph: (260) 463-3421 |
Dr. Ricky Lee Weidow, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 201 W Wayne St, Lagrange, IN 46761 Phone: 260-463-3421 Fax: 260-463-7347 |