1871628347 NPI number — LANTER EYECARE & LASER SURGERY PC

Table of content: (NPI 1871628347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871628347 NPI number — LANTER EYECARE & LASER SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANTER EYECARE & LASER SURGERY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871628347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10610 N PENNSYLVANIA ST
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46280-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-844-6269
Provider Business Mailing Address Fax Number:
317-815-7567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 E COUNTY LINE RD
Provider Second Line Business Practice Location Address:
STE M
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46143-1050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-844-6269
Provider Business Practice Location Address Fax Number:
317-815-7567
Provider Enumeration Date:
02/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANTER
Authorized Official First Name:
EARL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-844-6269

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0111609909 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: 0004923421 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X , with the licence number: 0111609909 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)