Healthcare Provider Details

I. General information

NPI: 1831129790
Provider Name (Legal Business Name): OPHTHALMIC PLASTIC SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ILLINOIS ST STE 220
CARMEL IN
46032-9847
US

IV. Provider business mailing address

11220 ILLINOIS ST STE 220
CARMEL IN
46032-9847
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1976
  • Fax: 317-817-1737
Mailing address:
  • Phone: 317-817-1976
  • Fax: 317-817-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LYNN SHEARER
Title or Position: DIRECTOR OF OPERATIONS
Credential: BA
Phone: 317-817-1976