Healthcare Provider Details

I. General information

NPI: 1376469064
Provider Name (Legal Business Name): MIDWEST EYE RETINA AND ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ILLINOIS ST STE 130
CARMEL IN
46032-9847
US

IV. Provider business mailing address

11220 ILLINOIS ST STE 130
CARMEL IN
46032-9847
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1586
  • Fax: 317-817-1399
Mailing address:
  • Phone: 317-817-1586
  • Fax: 317-817-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGEL SMITH
Title or Position: MANAGER
Credential:
Phone: 317-805-2161