RICKY L WEIDOW

Dr RICKY L WEIDOW is a male medical professional, specializing in Optometry. He graduated in 1993 from Southern College Of Optometry.

Contact

201 W WAYNE ST
LAGRANGE
IN
467611850

Tel:

RICKY L WEIDOW Information

Npi 1639177793
Pac Id 8921022328
Professional Enrollment Id I20091223000119
Last Name WEIDOW
First Name RICKY
Middle Name L
Suffix
Gender M
Credential
Medical School Name SOUTHERN COLLEGE OF OPTOMETRY
Graduation Year 1993
Primary Specialty OPTOMETRY
Secondary Specialty 1
Secondary Specialty 2
Secondary Specialty 3
Secondary Specialty 4
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Organization Legal Name
Group Practice Pac Id
Number Of Group Practice Members
Line 1 Street Address 201 W WAYNE ST
Line 2 Street Address
Marker Of Address Line 2 Suppression
City LAGRANGE
State IN
Zip Code 467611850
Phone Number
Hospital Affiliation Ccn 1
Hospital Affiliation Lbn 1
Hospital Affiliation Ccn 2
Hospital Affiliation Lbn 2
Hospital Affiliation Ccn 3
Hospital Affiliation Lbn 3
Hospital Affiliation Ccn 4
Hospital Affiliation Lbn 4
Hospital Affiliation Ccn 5
Hospital Affiliation Lbn 5
Professional Accepts Medicare Assignment Y

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