Provider Demographics
NPI:1427056829
Name:MORROW, DOUGLAS C (OD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:MORROW
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 1:1212 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-1232
Mailing Address - Country:US
Mailing Address - Phone:260-925-1916
Mailing Address - Fax:260-925-2632
Practice Address - Street 1:1212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1232
Practice Address - Country:US
Practice Address - Phone:260-925-1916
Practice Address - Fax:260-925-2632
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001791B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT69206Medicare UPIN