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EVERGREEN EYE CLINIC
NPI 1174740682
Optometrist in Lagrange, IN

Active since April 19, 2007
201 W WAYNE ST, LAGRANGE, IN 46761(260) 463-3421(260) 463-7347 Get Directions Write a Review

NPPES record last updated: February 27, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Evergreen Eye Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN EYE CLINIC (NPI 1174740682) is a healthcare organization registered as an optometrist in Lagrange, Indiana and active in the NPI registry since April 2007. The organization lists Ricky Lee Weidow, President, as its authorized official.

NPPES Registry Identity

NPI1174740682
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameRENAISSANCE OCULAR DISEASE AND TRAUMA FOUNDATION, INC.
Location Address201 W WAYNE STLagrange, IN 46761-1850
Mailing Address201 W Wayne St, Po Box 150Lagrange, IN 46761-1850 · (260) 463-3421 · Fax (260) 463-7347
Phone(260) 463-3421
Fax(260) 463-7347
Organization SubpartNo
Authorized OfficialRicky Lee WeidowPresident · (260) 463-3421
Enumeration DateApril 19, 2007
Last NPPES UpdateFebruary 27, 2010
✔ NPI 1174740682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in IN · 18002670A/B
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Also ListedEyewear SupplierTaxonomy 332H00000X · License 18002670A/B (IN)
201 W WAYNE ST, Lagrange, IN 46761
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Other Names 1

Doing Business AsEvergreen Eye Clinic

Other Identifiers 22

Other2604633421IN · Vision Service Plan Lagrange
Medicaid200097680CIN
Medicare PIN180230IN
Medicare PIN461830IN
Other000000257711IN · Anthem Bc/bs Lagrange
Other000000635212IN · Anthem Nwielc Knox
Other1639177793IN · Ricky Weidow Npi
Medicare NSC4002320001IN
Medicare PIN169230IN
Other2605932505IN · Vision Service Plan Topeka
Other5742334109IN · Vision Service Plan South Bend
Medicare PIN461830AIN
Medicare PIN169220IN
Medicare PIN410043916IN
Medicare UPINU62249IN
Medicaid200097680DIN
Medicare NSC4002320002IN
Medicare PIN169220AIN
Medicaid200097680EIN
Other000000257712IN · Anthem Bc/bs Topeka
Medicare PIN169230AIN
Medicare PIN410043915IN

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RICKY LEE WEIDOW O.D.
Optometrist
201 W WAYNE ST
LAGRANGE, IN 46761
Lagrange County (260) 463-3421

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Renaissance Ocular Disease And Trauma Foundation, Inc.'s NPI number?

The NPI number for Renaissance Ocular Disease And Trauma Foundation, Inc. is 1174740682. It was assigned to this organization in the NPPES registry on April 19, 2007. The provider is doing business as Evergreen Eye Clinic.

Where is Renaissance Ocular Disease And Trauma Foundation, Inc. located?

Renaissance Ocular Disease And Trauma Foundation, Inc. is located at 201 W Wayne St, Lagrange, IN 46761. The listed phone number is (260) 463-3421.

What is Renaissance Ocular Disease And Trauma Foundation, Inc.'s specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

When was this NPI record last updated?

The NPPES record for Renaissance Ocular Disease And Trauma Foundation, Inc. was last updated on February 27, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.