Healthcare Provider Details

I. General information

NPI: 1184625436
Provider Name (Legal Business Name): INDIANA PEDIATRIC OPHTHALMOLOGY & ADULT STRABISMUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR SUITE 3340
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

1160 W MICHIGAN ST SUITE 217
INDIANAPOLIS IN
46202-5209
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-8103
  • Fax: 317-944-1111
Mailing address:
  • Phone: 317-274-1214
  • Fax: 317-274-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID A PLAGER
Title or Position: DIRECTOR
Credential: MD
Phone: 317-274-1214