Healthcare Provider Details

I. General information

NPI: 1497891204
Provider Name (Legal Business Name): EYE SPECIALISTS OF INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N MERIDIAN ST
INDIANAPOLIS IN
46202-1303
US

IV. Provider business mailing address

1901 N MERIDIAN ST
INDIANAPOLIS IN
46202-1303
US

V. Phone/Fax

Practice location:
  • Phone: 317-925-2200
  • Fax:
Mailing address:
  • Phone: 317-925-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number50003538A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number50003538A
License Number StateIN

VIII. Authorized Official

Name: WENDY KRIBLEY
Title or Position: BILLING DEPT MANAGER
Credential:
Phone: 317-920-4575