1366701880 NPI number — EYECARE INDIANA, P.C.

Table of content: (NPI 1366701880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366701880 NPI number — EYECARE INDIANA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE INDIANA, 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:
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:
1366701880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9795 CROSSPOINT BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-254-6480
Provider Business Mailing Address Fax Number:
317-259-8609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 S STATE ROAD 135
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46143-6386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-535-4049
Provider Business Practice Location Address Fax Number:
317-259-8609
Provider Enumeration Date:
05/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OSSIP
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
317-254-6480

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18001705A , 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)





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