Healthcare Provider Details

I. General information

NPI: 1558000711
Provider Name (Legal Business Name): MIDWEST EYE CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 S STATE ROAD 135 STE C
GREENWOOD IN
46143-6481
US

IV. Provider business mailing address

PO BOX 549
WABASH IN
46992-0549
US

V. Phone/Fax

Practice location:
  • Phone: 317-883-2020
  • Fax:
Mailing address:
  • Phone: 260-782-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CATHY GARRETT
Title or Position: COO
Credential:
Phone: 260-569-9550