1528203270 NPI number — EYEQ OPTOMETRY P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528203270 NPI number — EYEQ OPTOMETRY P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYEQ OPTOMETRY P. C.
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:
DR. LAWRENCE HEMINGWAY
Provider Other Organization Name Type Code:
4
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:
1528203270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9302 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-848-4444
Provider Business Mailing Address Fax Number:
317-848-7976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9302 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-1873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-848-4444
Provider Business Practice Location Address Fax Number:
317-848-7976
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HEMINGWAY
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-848-4444

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18002591B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200495780 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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