Healthcare Provider Details

I. General information

NPI: 1477633071
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: 10/17/2006
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NORTH MERIDIAN STREET
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

1901 NORTH MERIDIAN STREET
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-925-2200
  • Fax: 317-921-6614
Mailing address:
  • Phone: 317-925-2200
  • Fax: 317-921-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number50003654A
License Number StateIN

VIII. Authorized Official

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