Healthcare Provider Details

I. General information

NPI: 1245501469
Provider Name (Legal Business Name): OSSIP OPTOMETRY, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 WINDFALL LN STE 130
CAMBY IN
46113-8022
US

IV. Provider business mailing address

9795 CROSSPOINT BLVD STE 100
INDIANAPOLIS IN
46256-3354
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5677
  • Fax: 317-856-5673
Mailing address:
  • Phone: 317-254-6480
  • Fax: 317-259-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001422
License Number StateIN

VIII. Authorized Official

Name: DR. GREGG L OSSIP
Title or Position: OWNER
Credential: O.D.
Phone: 317-254-6480