Healthcare Provider Details

I. General information

NPI: 1639353725
Provider Name (Legal Business Name): OSSIP OPTOMETRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 WINDFALL LANE SUITE 130
CAMBY IN
46113
US

IV. Provider business mailing address

5455 HARRISON PARK LANE
INDIANAPOLIS IN
46216
US

V. Phone/Fax

Practice location:
  • Phone: 317-821-3500
  • Fax: 317-821-3533
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 Number
License Number StateIN

VIII. Authorized Official

Name: MRS. KATHY J LONG
Title or Position: DIRECTOR OF OPERATIONS FINANCE
Credential:
Phone: 317-254-6480