Healthcare Provider Details

I. General information

NPI: 1275881765
Provider Name (Legal Business Name): MIDWEST EYE CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 S EMERSON AVE
INDIANAPOLIS IN
46237-1969
US

IV. Provider business mailing address

PO BOX 549
WABASH IN
46992-0549
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-8700
  • Fax: 317-783-5987
Mailing address:
  • Phone: 260-569-9550
  • Fax: 260-569-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number56000164A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number170012434A
License Number StateIN

VIII. Authorized Official

Name: GREGORY L GARNER
Title or Position: PRES/CEO
Credential: OD
Phone: 260-569-9550