Healthcare Provider Details

I. General information

NPI: 1194758672
Provider Name (Legal Business Name): MIDWEST GLAUCOMA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 N ILLINOIS ST SUITE 1010
INDIANAPOLIS IN
46290-1164
US

IV. Provider business mailing address

10300 N ILLINOIS ST SUITE 1010
INDIANAPOLIS IN
46290-1164
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1768
  • Fax: 317-817-1777
Mailing address:
  • Phone: 317-817-1768
  • Fax: 317-817-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number50002846A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT MARTIN TROYER
Title or Position: OPHTHALMOLOGIST
Credential: M.D.
Phone: 317-817-1768