Jack, Colin N

Jack, Colin N is an individual health care provider with primary practice located at 2101 Burlington Beach Rd. Suite D, Valparaiso IN 46383-0000. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jack, Colin N can be contacted via phone (219) 462-0309.

Contact Information

Primary practice address
2101 Burlington Beach Rd. Suite D Valparaiso IN 46383-0000
Phone: (219) 462-0309
Fax: (219) 464-4291
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 18002034 Indiana

Profile Details

NPI number 1700853637
LBN Legal business name Jack, Colin N
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Feb 4th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700853637 NPPES
Indiana MEDICAID 100208430B

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