Healthcare Provider Details

I. General information

NPI: 1306260815
Provider Name (Legal Business Name): SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W 86TH ST
INDIANAPOLIS IN
46260-2076
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL LOUIS WALTON
Title or Position: CEO/ OWNER
Credential:
Phone: 317-925-2200