1588991228 NPI number — THE EYE SURGICAL CENTER OF FORT WAYNE, LLC

Table of content: DR. RANA NAIMEH KHOURY PHARMD (NPI 1265941314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588991228 NPI number — THE EYE SURGICAL CENTER OF FORT WAYNE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EYE SURGICAL CENTER OF FORT WAYNE, LLC
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:
1588991228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 E WAYNE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46802-2713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-422-5976
Provider Business Mailing Address Fax Number:
260-424-4511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 E WAYNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46802-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-422-5976
Provider Business Practice Location Address Fax Number:
260-424-4511
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PARENT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
REX
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
260-422-5976

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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