Provider Demographics
NPI:1518060151
Name:N.D. OGLESBEE, O.D., INC.
Entity type:Organization
Organization Name:N.D. OGLESBEE, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:OGLESBEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-773-4732
Mailing Address - Street 1:207 EAST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550
Mailing Address - Country:US
Mailing Address - Phone:574-773-4732
Mailing Address - Fax:574-773-2164
Practice Address - Street 1:207 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-2119
Practice Address - Country:US
Practice Address - Phone:574-773-4732
Practice Address - Fax:574-773-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001832B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200158020AMedicaid
IN0198900001Medicare NSC
IN200158020AMedicaid
IN184170Medicare PIN