MEDICARE: UNIVERSITY EYE CARE SC

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	207W00000X	Ophthalmology Physician	99036106A	IN

General Provider Information

NPI Number	:	1508004128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY EYE CARE SC

Provider Business Mailing Address
First Line	:	2720 169TH ST
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1508
Country	:	US
Telephone Number	:	219-845-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 169TH ST
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1508
Country	:	US
Telephone Number	:	219-845-2020
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	PREMAL PATEL
Credential	:
Telephone Number	:	630-920-5880

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	02/04/2009

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Directions to “UNIVERSITY EYE CARE SC ” Practice Location

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