DR. DOUGLAS ERIC WIDMER O.D. NPI 1710269550

Optometrist in South Bend, IN

About DOUGLAS WIDMER

Douglas Widmer is a provider in South Bend, IN with more than 7 years of experience. The NPI number assigned to this provider is 1710269550. The practitioner's primary taxonomy code is Optometrist (152W00000X). The provider is registered as an individual and their NPI record was last updated 5 years ago. Douglas Widmer is registered with Medicare and accepts claims assignment.

NPI1710269550 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameDR. DOUGLAS ERIC WIDMER O.D.
Provider Location Address4121 S. MICHIGAN STREET SOUTH BEND, IN 46614 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address4121 S. MICHIGAN STREET SOUTH BEND, IN 46614 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameOHIO STATE UNIVERSITY - COLLEGE OF OPTOMETRY
Graduation Year2011
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date09-19-2011 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date03-25-2013 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

DR. DOUGLAS ERIC WIDMER O.D.
4121 S. MICHIGAN STREET
SOUTH BEND, IN
ZIP 46614
Phone: (574) 291-9200
Fax: (574) 299-4423
Get Directions

Mailing Address

DR. DOUGLAS ERIC WIDMER O.D.
4121 S. MICHIGAN STREET
SOUTH BEND, IN
ZIP 46614
Phone: (574) 291-9200
Fax: (574) 299-4423

Primary Taxonomy

Taxonomy Code152W00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationOptometrist
TypeEye and Vision Services Providers
License No.18003697A
License StateIN
Taxonomy DescriptionDoctors 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.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
M400067198MEDICARE PIN (08)IN
201034430MEDICAID (05)IN

Map Location


DR. DOUGLAS ERIC WIDMER O.D. address is 4121 S. MICHIGAN STREET SOUTH BEND, IN 46614

Other Providers at the same location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1306813464 LAWRENCE A SHINNEMAN O.D.
Individual
Optometrist4121 S. MICHIGAN STREET
SOUTH BEND, IN 46614
(574) 291-9200
1316935208DR. MICHAEL JOHN ROTHEKER O.D.
Individual
Optometrist4121 S. MICHIGAN STREET
SOUTH BEND, IN 46614
(574) 291-9200
1447516604EYECARE INDIANA LL, PC
Organization
Optometrist4121 S. MICHIGAN STREET
SOUTH BEND, IN 46614
(574) 291-9200