1649552902 NPI number — INDIANA UNIVERSITY EYE CARE, INC.

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 1649552902 NPI number — INDIANA UNIVERSITY EYE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY EYE CARE, INC.
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:
IU EYE CARE INC.
Provider Other Organization Name Type Code:
5
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:
1649552902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 W MICHIGAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-5209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-274-2020
Provider Business Mailing Address Fax Number:
317-274-3265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W 103RD ST
Provider Second Line Business Practice Location Address:
SUITE 2250
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46290-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-274-2020
Provider Business Practice Location Address Fax Number:
317-274-3265
Provider Enumeration Date:
09/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CANTOR
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
317-278-2651

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18003053 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , 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)

  • Identifier: 100067460 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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