MEDICARE: OSSIP OPTOMETRY, P.C

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	18001611	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639513427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSSIP OPTOMETRY, P.C

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

Provider Business Practice Location Address
First Line	:	1033 JACKSON ST
Second Line	:	STE C
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5780
Country	:	US
Telephone Number	:	812-376-3068
Fax Number	:	812-376-6771

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGG L OSSIP
Credential	:	OD
Telephone Number	:	317-254-6480

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	10/13/2015

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