Healthcare Provider Details

I. General information

NPI: 1013905827
Provider Name (Legal Business Name): INDIANA EYE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N EMERSON AVE
GREENWOOD IN
46143-8895
US

IV. Provider business mailing address

30 N EMERSON AVE
GREENWOOD IN
46143-8895
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-3937
  • Fax: 317-887-4008
Mailing address:
  • Phone: 317-881-3937
  • Fax: 317-887-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROL SCHLARB
Title or Position: OFFICE MANAGER
Credential:
Phone: 317-881-3937