Healthcare Provider Details

I. General information

NPI: 1871686816
Provider Name (Legal Business Name): OSSIP OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9795 CROSSPOINT BLVD STE 100
INDIANAPOLIS IN
46256-3354
US

IV. Provider business mailing address

9795 CROSSPOINT BLVD STE 100
INDIANAPOLIS IN
46256-3354
US

V. Phone/Fax

Practice location:
  • Phone: 317-254-6480
  • Fax: 317-259-8609
Mailing address:
  • Phone: 317-254-6480
  • Fax: 317-259-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001899
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01060284
License Number StateIN

VIII. Authorized Official

Name: DR. GREGG L OSSIP
Title or Position: OWNER
Credential: OD
Phone: 317-254-6480