MEDICARE: CITY OPTICAL CO., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1093513137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OPTICAL CO., INC.

Provider Business Mailing Address
First Line	:	2839 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-2147
Country	:	US
Telephone Number	:	317-643-3204
Fax Number	:	855-326-4293

Provider Business Practice Location Address
First Line	:	4401 E 10TH ST STE 3
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-2754
Country	:	US
Telephone Number	:	317-643-3204
Fax Number	:	855-326-4293

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MEGAN BLAKE
Credential	:
Telephone Number	:	317-924-1300

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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Directions to “CITY OPTICAL CO., INC. ” Practice Location

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