Renaissance Ocular Disease and Trauma Foundation, Inc.

NPI #1174740682 in Lagrange, Indiana

Provider Information

NPI Number: 1174740682
Entity Type: Organization
Organization Name: Renaissance Ocular Disease and Trauma Foundation, Inc.
Primary Specialty: Optometrist
Enumeration Date: Apr 19, 2007
Last Updated: Feb 27, 2010

Practice Location

Address: 201 W WAYNE ST
City: Lagrange
State: Indiana
ZIP Code: 46761-1850
Phone: (260) 463-3421

Authorized Official

Name: DR. RICKY LEE WEIDOW, O.D.
Title: PRESIDENT
Phone: (260) 463-3421

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X
Optometrist	152W00000X	Primary

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