MEDICARE: MIDWEST EYE CONSULTANTS, 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

General Provider Information

NPI Number	:	1952874422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST EYE CONSULTANTS, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:
City	:	WABASH
State	:	IN
Zip	:	46992-0549
Country	:	US
Telephone Number	:	260-569-9550
Fax Number	:	260-569-9244

Provider Business Practice Location Address
First Line	:	2750 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3125
Country	:	US
Telephone Number	:	812-372-4463
Fax Number	:	812-372-2802

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CATHY GARRETT
Credential	:	BS, COE
Telephone Number	:	260-569-9550

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	06/09/2022

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