1285741397 NPI number — INDIANAPOLIS OPHTHALMOLOGY PC

Table of content: SAMANTHA G. CAPPETTO MD (NPI 1427430958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285741397 NPI number — INDIANAPOLIS OPHTHALMOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANAPOLIS OPHTHALMOLOGY 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:
6
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:
1285741397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 CITY CENTER DR STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-846-4223
Provider Business Mailing Address Fax Number:
317-846-6063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N. SENATE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 620
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-926-6699
Provider Business Practice Location Address Fax Number:
317-921-1723
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DILTS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
317-846-4223

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100056740 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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