Provider Demographics
NPI:1285717603
Name:RUMSCHLAG, SAMUEL L (OD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:RUMSCHLAG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 W CARMEL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5877
Mailing Address - Country:US
Mailing Address - Phone:317-846-3937
Mailing Address - Fax:317-846-4423
Practice Address - Street 1:755 W CARMEL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5877
Practice Address - Country:US
Practice Address - Phone:317-846-3937
Practice Address - Fax:317-846-4423
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001681A152W00000X
IN18001681B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN438430Medicare ID - Type Unspecified
INT98133Medicare UPIN
IN0959350001Medicare NSC