Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. RICKY LEE WEIDOW, O.D.
ActiveDR. RICKY LEE WEIDOW, O.D. is a Optometrist healthcare provider located in LAGRANGE, Indiana. NPI 1639177793 is currently active in the NPPES registry. Verify at CMS.
Optometrist · LAGRANGE, IN
Registration Details
- NPI Number
- 1639177793
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 12, 2005 (21.104745412564 yrs)
- Last Updated
- Feb 14, 2010
- Licenses
-
18002670A/B (IN)18002670A/B (IN)18002670A/B (IN)
Practice Information
- Address
-
201 W WAYNE STLAGRANGE, IN, 467611850Browse IN providers · Browse ZIP 46761
- Phone
- 2604633421
- Fax
- 2604637347
- Primary Specialty
-
Optometrist
152W00000X
- Additional Specialty
- Corneal & Contact Management Optometrist
- Additional Specialty
- Pediatric Optometrist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.