Healthcare Provider Details

I. General information

NPI: 1912960535
Provider Name (Legal Business Name): MIDWEST EYE CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7747 W JEFFERSON BLVD SUITE A
FORT WAYNE IN
46804-4135
US

IV. Provider business mailing address

PO BOX 549
WABASH IN
46992-0549
US

V. Phone/Fax

Practice location:
  • Phone: 260-459-8444
  • Fax: 260-459-8443
Mailing address:
  • Phone: 260-459-8444
  • Fax: 260-459-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY L GARNER
Title or Position: PRES./CEO
Credential: O.D.
Phone: 260-569-9550