Healthcare Provider Details

I. General information

NPI: 1942349287
Provider Name (Legal Business Name): EYE SPECIALIST OF INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W JEFFERSON ST
FRANKLIN IN
46131-2147
US

IV. Provider business mailing address

1901 N MERIDIAN ST
INDIANAPOLIS IN
46202-1303
US

V. Phone/Fax

Practice location:
  • Phone: 317-738-2020
  • Fax:
Mailing address:
  • Phone: 317-925-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number50003538A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number50003538A
License Number StateIN

VIII. Authorized Official

Name: CYNTHIA L STAHL
Title or Position: BILLING DEPT MGR
Credential: CPC, CCS-P, CPC-H
Phone: 317-920-4575