Basic Information
| Provider Information | |||||||||
| NPI: | 1265688816 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | R W BARON INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BARON VISION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467331802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607244318 | ||||||||
| FaxNumber: | 2607249776 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467331802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607244318 | ||||||||
| FaxNumber: | 2607249776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2008 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BARON | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2607244318 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D.,F.A.A.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | IN | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 152W00000X | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.