Provider Demographics
NPI:1568443182
Name:MAGWIRE, BRIAN PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:MAGWIRE
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 1:407 W MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1428
Mailing Address - Country:US
Mailing Address - Phone:260-665-5918
Mailing Address - Fax:260-665-5918
Practice Address - Street 1:407 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1428
Practice Address - Country:US
Practice Address - Phone:260-665-5918
Practice Address - Fax:260-665-5918
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002144B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4492730001OtherDMERC
IN000000305660OtherBLUECROSS BLUESHIELD PIN
INT69267Medicare UPIN
IN770980Medicare ID - Type Unspecified