Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 1026514 | IN |
NPI | 1013913771 |
---|---|
Provider Name | Mr. Eldi E Deschamps |
First Address | Merrillville, IN 46410-7032 |
Second Address | Merrillville, IN 46410-7032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 19/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200079690 | (05) | IN |
B29107 | (02) | IN |